Overview
The Ulcer Process
A peptic ulcer is a mucosal defect in the stomach or duodenum that extends through the muscularis mucosae.
A peptic ulcer is a mucosal defect in the stomach or duodenum that extends through the muscularis mucosae. It develops when acid and pepsin overwhelm protective mechanisms such as mucus and bicarbonate secretion, epithelial repair, adequate mucosal blood flow, and prostaglandin activity. The two leading causes are Helicobacter pylori infection and chronic use of nonsteroidal anti-inflammatory drugs (NSAIDs). H. pylori inhabits the gastric mucus layer and produces persistent inflammation that weakens the mucosal barrier. NSAIDs inhibit cyclooxygenase and reduce protective prostaglandins; the result is less mucus and bicarbonate, poorer mucosal blood flow, and greater vulnerability to acid. NSAIDs can also impair platelet function, so an NSAID-related ulcer may bleed more readily. Corticosteroids alone are not usually the primary cause, but their combination with NSAIDs increases ulcer risk. Smoking, prior ulcer disease, older age, anticoagulant or antiplatelet therapy, and severe physiologic stress can increase the likelihood of complications. Dietary changes may reduce discomfort for an individual patient, but a “bland diet” does not remove H. pylori or repair NSAID-related loss of mucosal protection. The location and depth of the ulcer determine...