A peptic ulcer is a defect in the lining of the stomach or the first part of the small intestine, an area called the duodenum. A peptic ulcer in the stomach is called a gastric ulcer. An ulcer in the duodenum is called a duodenal ulcer.
Etiology & Pathophysiology
One’s digestive tract is coated with a mucous layer that normally protects against acid. But if the amount of acid is increased or the amount of protective mucous layer is decreased, he or she could develop an ulcer. Most ulcers occur in the first layer of the inner lining. A hole that goes all the way through the stomach or duodenum is called a perforation and is a medical emergency. The most common cause of such damage is infection of the stomach by bacteria called Helicobacter pylori (H.pylori). Most people with peptic ulcers have these bacteria living in their gastrointestinal (GI) tract. Helicobacter pylori release a toxin that promotes mucosal inflammation and ulceration. Helicobacter pylori also cause apoptosis and causes DNA damage in gastric epithelial cells. When apoptosis occurs and DNA damage occurs, inflammation occurs when substances enter the stomach that is inflamed and causes irritation of the stomach lining. Too much irritation of the lining then leads to ulcers developing. Regular use of some antibiotics can also erode the mucosal lining of the stomach like aspirin, several antibiotics such as tetracycline, quinidine, potassium chloride and others. Furthermore, regular use of aspirin, ibuprofen, naproxen, or other non-steroidal anti-inflammatory drugs (NSAIDs) can erode the mucosal lining of the stomach as well. Investigators believe that NSAIDs can cause a gastric ulcer by inhibiting prostaglandins (the fatty acids that the stomach release which regulate acid secretion). Exposure to irritants like certain drugs and alcohol can also inhibit prostaglandin secretion in the stomach triggering a mechanism much like the one caused by NSAIDs. So, drinking too much alcohol can irritate and erode the lining of the stomach making it easier for ulcers to develop. Also, caffeine and nicotine increases the acid concentration in the stomach making it easier for inflammation to occur and ulcers develop. Tobacco on the other hand interferes with the mechanisms that usually protect the lining of the stomach and intestine and causes pepsin to be released that makes ulcers worsen. Cigarette smoking evidently inhibits pancreatic secretion of sodium bicarbonate (an alkali) which is needed to neutralize stomach acid to prevent acid from burning the mucosal lining of the stomach and causing inflammation and ulcers. Pyloric sphincter can also wear down during the normal aging process which in turn permits the bile reflux into the stomach. Stagnant food in the stomach can lead to increased gastric pressure and excessive production of stomach acid to digest the contents in the stomach. More acid produced the more the likelihood of ulcers developing. Also trauma patients who experienced critical illnesses, shock, or had severe tissue injury from extensive burns or intracranial surgery may develop an ulcer. Moreover, certain illnesses like Chron’s disease and Zollinger-Ellison syndrome are associated with ulcer development. People with Zollinger-Ellison syndrome have a tumor in their pancreas which releases high levels of gastrin (a hormone) that increases stomach acid which can then lead to ulcers development. In the case of Chron’s disease immunity cells destroy the gastric cells thus damaging the mucosal lining of the stomach causing inflammation and ulcers eventually develop. Psychogenic factors like stress cause ulcers too. Investigators believe stress causes long term overproduction of gastric secretions that aid in ulcer production by eroding stomach, duodenal and intestinal tissue. Yet, there is not enough research available thus far to confirm the trueness of this statement, at least for everyday stress at home. Genetics play a part in ulcer...
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