Aetiology
In both types of peptic ulceration, gastric and duodenal, there is an imbalance between secretion and neutralization of secreted acid. In duodenal ulcers there is an over-secretion of acid whilst in gastric ulcers there is an impairment of mucosal protection.
The two major aetiological factors responsible for peptic ulceration are infection by the gram-negative gastric pathogen Helicobacter pylori and the use of aspirin and non-steroidal anti-inflammatory drugs (NSAIDs). There is some synergy between these two major causes (1)
Other risk factors in the development of peptic ulceration include:
- heredity
- ageing
- stress (2)
- smoking (twice as common in people with chronic peptic ulcer than the general population) (3)
- hypercalcaemia
- colchicine therapy
- renal failure - gastrin, like other peptide hormones, is metabolised in the kidney and hypergastrinaemia is one factor predisposing to peptic ulceration in uraemic patients
References
- Huang JQ, Sridhar S, Hunt RH. Role of Helicobacter pylori infection and nonsteroidal anti-inflammatory drugs in peptic-ulcer disease: a meta-analysis. Lancet. 2002 Jan 5;359(9300):14-22
- Levenstein S, Rosenstock S, Jacobsen RK, et al. Psychological stress increases risk for peptic ulcer, regardless of Helicobacter pylori infection or use of nonsteroidal anti-inflammatory drugs. Clin Gastroenterol Hepatol. 2015 Mar;13(3):498-506.
- Garrow D, Delegge MH. Risk factors for gastrointestinal ulcer disease in the US population. Dig Dis Sci. 2009 Jan 22;55(1):66-72.
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