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

1. 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
2. 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.
3. Garrow D, Delegge MH. Risk factors for gastrointestinal ulcer disease in the US population. Dig Dis Sci. 2009 Jan 22;55(1):66-72.