Peptic Ulcer

Description

Peptic ulcer disease is a chronic ulcer in the lining of the gastrointestinal tract. There are several locations: duodenal, gastric, esophageal, and ectopic.

Duodenal ulcers are located in the duodenal bulb. Multiple ulcers, and if distal to the bulb raise the possibility of Zollinger-Ellison syndrome. Duodenal ulcers are 4 times more common than gastric ulcers.

Gastric ulcers are most commonly located along the lesser curvature of the antrum near the incisura and in the pre-pyloric area. Gastric ulcers are 3-4 times as common as duodenal ulcers among NSAID users.

A peptic ulcer in the distal esophagus may be part of Barrett's epithelial change due to chronic reflux of gastroduodenal contents.

Ectopic gastric mucosal ulceration may develop in patients with Meckel's diverticula or other sites of ectopic gastric mucosa.

Causes

The cause of of duodenal and gastric ulcers is multifactorial. H. pylori gastritis is present in >90% of duodenal and >75% of gastric ulcers (H. pylori appears to be a requisite factor). An imbalance between aggressive factors (e.g., gastric acid, pepsin, bile salts, pancreatic enzymes) and defensive factors maintaining mucosal integrity (e.g., mucus, bicarbonate, blood flow, prostaglandins, growth factors, cell turnover) may allow H. pylori to grow. Ulcerogenic drugs (e.g., NSAID's) harm the gastric mucosa. Zollinger-Ellison syndrome causes excessive gastric acid secretion which damages gastric mucosa.

Peptic ulcers are strongly associated with cigarette smoking (more than 1/2 pack/day). Other risk factors include: drugs (e.g., NSAID use), family history of ulcer, and Zollinger-Ellison syndrome (gastrinoma). It is possibly associated with: Corticosteroids (high dose and/or prolonged therapy); blood group O; HLA-B12, B5, Bw35 phenotypes; stress; lower socioeconomic status; and manual labor. It is poorly or not associated with dietary spices, alcohol, caffeine, and acetaminophen.