Peptic Ulcer

Basics

Description

  • Produced by breakdown in gastric, distal esophageal, or duodenal mucosa defenses
  • Imbalance exists between gastric protective and destructive factors

Etiology

  • Helicobacter pylori:
    • Gram-negative spiral bacteria that live in mucous layer
    • Responsible for 90% of duodenal ulcers and 70–90% of gastric ulcers
    • Secrets urease that breaks down and neutralizes gastric acid thus protecting itself
    • Secrets toxins that break down mucosa
    • Has flagella that move bacteria toward epithelium
  • NSAIDs:
    • Interfere with prostaglandin synthesis
    • Lead to break in mucosa
  • Aspirin
  • Cigarette smoking
  • Alcohol
  • Severe physiologic stress
  • Hypersecretory states (uncommon)
  • Ischemic causes (eg, shock, sepsis, or critical illness)
  • Genetics (>20% have family history)

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