Whenever winter comes, cardiovascular and cerebrovascular diseases make frequent appearances, such as cerebral haemorrhage and myocardial infarction, which are common among people. So, for young people suffering from peptic ulcer, or middle-aged and elderly patients with cirrhosis combined with oesophagogastric fundal varices, will the cold climate aggravate the condition or even increase the risk of bleeding? Dr Song Jitao, secretary-general of the Digestive Disease Branch of the Heilongjiang Provincial Association for the Promotion of International Exchanges in Health Care and chief physician of the Gastroenterology Department of the Second Affiliated Hospital of Harbin Medical University, pointed out that, according to the results of domestic and foreign studies, it has been confirmed that, as an independent factor triggering or exacerbating the bleeding of peptic ulcers, the drastic climatic changes can indeed bring certain risks, suggesting that people must change their bad habits, and pay attention to the prevention of cold weather in the daily warmth.

Song Jitao said that the most common diseases in gastroenterology mainly include esophagogastric fundal variceal rupture bleeding (EGVB), peptic ulcer bleeding, etc. EGVB is a bleeding symptom triggered by the rupture of esophagogastric fundal variceal vein, which accounts for about 20% of the upper gastrointestinal tract bleeding, and it has always been a common and urgent complication for patients with cirrhosis, and also one of the common causes of upper gastrointestinal bleeding. About 7-8% of cirrhosis cases progress to oesophagogastric fundal varices every year. After a single rough meal, there is a risk of rupture of the blood vessel and subsequent vomiting of blood and black stools. Over the decades, experts and scholars have continued to explore the mysteries of EGVB pathogenesis with great dedication and to develop cutting-edge treatment protocols and guidelines based on existing mechanisms.

What’s Wrong With Digestive Bleeding

So how do the blood vessels lurking in the oesophagus and fundus press the “trigger” for varicose veins? Dr Song pointed out that when it comes to varicose veins in the oesophagus and fundus of the stomach, it must first be explained from the point of view of the liver and cirrhosis of the liver. The liver is the largest and most efficient digestive organ in the human body, and during activities such as eating to take in nutrients, the liver recycles blood from the intestines through a special supply channel, the portal vein, and then supplies the recuperated blood to the hepatic lobules (lobules of the liver) in the liver by numerous branch vessels. The blood is then supplied by numerous branch vessels to the lobules (the basic functional units of the liver); the lobules are made up of countless hepatocytes arranged in an orderly fashion, and the blood is processed by the liver to retrieve the nutrients and reuse them, and at the same time effectively dispose of the metabolic wastes, which are collected by the inferior vena cava and introduced into the body circulation.

However, under the attack of viruses, alcohol and other toxic and harmful substances, human liver cells are often destroyed, and then necrosis and apoptosis. However, liver cells are indomitable, and the will of “regeneration” is very tenacious, but it is easy to lose the original order on the way of “resurrection”, resulting in the previously ordered liver lobules becoming structurally disordered “pseudo lobe”, and this “pseudo lobe” is a kind of “pseudo lobe”. “The consequences of this “mutated form” block the original smooth pipeline, resulting in the flow of blood from the portal vein into the liver is blocked, the road ahead is blocked, the portal vein pressure continues to soar, the blood has to “find another way” to alleviate the continuously rising portal vein pressure. The pressure in the portal vein continued to rise, and the blood had to “find another way” to relieve the continuously rising pressure in the portal vein, so the once dormant “collateral circulation” was awakened, and oesophagogastric varices were formed, thus laying a “landmine” for the patient to vomit blood.

Compared with EGVB, the harm of peptic ulcer bleeding should not be underestimated. Dr. Song Jitao said that this disease occupies 60-70% of the causes of upper gastrointestinal bleeding, patients tend to vomit a large amount of dark red blood at the onset, accompanied by blood clots; bleeding is large, you will also see bright red blood gushing out, and then black stools, and at the same time, presenting anaemia, the body’s blood volume is reduced and even shock and life-threatening. According to the “leaky roof” theory of the digestive tract mucosa, Dr Song suggests that gastric and duodenal ulcers will come “uninvited” when infected with Helicobacter pylori bacteria, irregular diet, long-term alcohol consumption or short-term large amounts of booze, and year-round use of aspirin and other non-steroidal anti-inflammatory drugs. “.

Cold weather can easily trigger persistent illnesses

Song Jitao reminds, the above two common digestive system diseases significantly present for seasonal, rhythmic attacks, easy to be climate change “rhythm”. Scholars in Taiwan clearly pointed out in a study that the mechanism for the increased incidence of ruptured oesophagogastric varices bleeding due to climatic factors is unclear, but during February and March, more human resources are needed to better manage the increased number of peptic ulcers and oesophagogastric variceal bleeding cases.

In 2016, doctors in Taiwan again published a paper stating that cold winter weather is associated with a high risk and incidence of ruptured variceal bleeding in the esophagus and that this conclusion is consistent with studies in Turkey, Japan, France, Tunisia, etc. In 2020, a paper by an American scholar in the Journal of Clinical Gastrointestinal Endoscopy came to the same conclusion that cold temperatures are a “push” factor in raising the incidence of peptic ulcers and ruptured variceal bleeding. Push hand” raised the risk and probability of existing or new esophagogastric fundal varices rupture bleeding, may be related to the application of non-steroidal anti-inflammatory drugs in the winter period of the elderly, cold days drink white wine to protect the cold and increase the liver load, as well as cold stimulation of sympathetic excitation, prompting peripheral vasoconstriction, so that the portal venous pressure steeply increased, overwhelmed, and ultimately caused the fundal vascular “burst”! “burst”.

As a precautionary measure, keep in mind the following recommendations

Dr Song cautioned that, like hypertension and diabetes, patients with “old stomach disease”, cirrhosis and portal hypertension should strengthen chronic disease management and quit bad habits to avoid acute and critical illnesses and complications. Specifically, the first one is “control your mouth”, eat less or not eat spicy, sour, cold, high salt, high fat, fried food; especially in the northern high latitude areas, due to the low temperature, short sunshine, many people will mistakenly know that drinking high degree of white wine can add heat to ward off the cold; not knowing that in the strong stimulation of alcohol, the gastric mucosa of the continued damage is huge. Gastric mucosal damage is huge, very easy to evolve into a peptic ulcer, at the same time make the liver overwhelmed, thus causing alcoholic liver disease (alcoholic cirrhosis), or make the original condition worse. It is an indisputable fact that patients with alcoholic cirrhosis often develop portal hypertension oesophagogastric varices “silently”. This suggests to us that “although good wine is good, don’t drink too much”.

The second is to prevent cold and keep warm, do not let the stomach cold. As the saying goes, “ten stomach disease nine cold”, Dr. Song Jitao explained, the weather turns cold, the body sympathetic nerves due to cold and excitement, easy to accelerate the contraction of peripheral blood vessels, forcing a large amount of blood from the body within a short period of time from the body circulation into the abdominal cavity of the portal vein system, with the rise in the portal vein pressure, naturally for the oesophago-gastric varicose vein rupture and bleeding laid the “ambush”. “The first thing you need to do is to get rid of it. Song Jitao suggested that people with bad stomachs should try not to go out when they encounter extreme weather, or go out wearing must be thicker; usually do not drink cold water or cold drinks, but to drink more jujube water or brown sugar water. Cover your stomach with a hot water bag every day, soak your feet in hot water at night, and cover your bedding before you go to sleep. In a word, “warmth” is good for their own health, do not give the stomach disease to take advantage of the opportunity, and put an end to the resurgence of old diseases.

Thirdly, rational use of medication to effectively protect blood vessels. Dr Song Jitao pointed out that in the northern cold region, many middle-aged and elderly people in order to ward off cardiovascular and cerebrovascular diseases, often preventive oral aspirin and other non-steroidal anti-inflammatory drugs, but the long-term use of aspirin will constitute damage to the digestive mucosa, induced by bleeding, suggesting the need to take medication according to medical advice. As for cirrhosis combined with oesophagogastric fundus varices “old patients”, in taking mucosal protective agents to protect the mucosa of the digestive tract at the same time, but also in the doctor and pharmacist under the guidance of the appropriate choice of some control of portal pressure drugs, such as carvedilol, propranolol and other classes of non-selective receptor blockers, can be on the portal system side branch! This can effectively reduce the pressure on the side branch of the portal vein system and further reduce the probability of bleeding.