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Peptic Ulcers (cont.)

Peptic Ulcers Causes

When you eat, your stomach produces hydrochloric acid and an enzyme called pepsin to digest the food.

The food is partially digested in the stomach and then moves on to the duodenum to continue the process.
Peptic ulcers occur when the acid and enzyme overcome the defense mechanisms of the gastrointestinal tract and cause an erosion in the mucosal wall.

The medical community long believed that ulcers were caused by lifestyle factors such as eating habits, cigarette smoking, and stress.

Gradually, researchers realized that people with ulcers had an imbalance between, on one hand, acid and pepsin, and on the other, the digestive tract's ability to protect itself from these harsh substances.
Research done in the 1980s showed that ulcers are actually caused by infection with a bacterium named Helicobacter pylori, usually called H pylori.
Not everyone who gets an ulcer is infected with H pylori. We now know that aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs) can cause ulcers if taken regularly.

While we no longer believe that lifestyle factors cause ulcers, we do believe that they play a role. Some types of medical therapy also can contribute to ulcer formation. The following factors can weaken the protective mucosal barrier of the stomach. This increases the chances of getting an ulcer and slows healing of existing ulcers.

Aspirin, nonsteroidal anti-inflammatory drugs (such as ibuprofen and naproxen), and newer anti-inflammatory medications (such as celecoxib [Celebrex])
Alcohol
Stress - Physical (severe injuries or burns, major surgery) or emotional
Caffeine
Cigarette smoking
Radiation therapy - Used for diseases such as cancer

People who take aspirin or other anti-inflammatory medication are at increased risk even if they do not have H pylori infection.

Elderly people with conditions such as arthritis are especially vulnerable.
People who have had ulcers or intestinal bleeding before are also at higher-than-normal risk.
If you take these medications regularly, you should talk to your health care provider about alternatives. This is especially true if you get an upset stomach or heartburn after taking one of these medications.

H pylori bacteria spread through the stools (feces) of an infected person.

The stool contaminates food or water (usually through poor personal hygiene).
The bacteria in the stool make their way into the digestive tracts of people who consume this food or water.
This is called fecal-oral transmission and is a common way for infections to spread.

The bacteria are found in the stomach, where they are able to penetrate and damage the lining of the stomach and duodenum.

Many people who are exposed to the bacteria never develop ulcers.
People who are newly infected usually develop symptoms within a few weeks.
Researchers are trying to discover what is different about the people who develop ulcers.

Infection with H pylori occurs in all ages, races, and socioeconomic classes.

It is more common in older adults, although it is thought that many people are infected in childhood and carry the bacteria throughout their lifetimes.
It is also more common in lower socioeconomic classes because these households tend to have more people living together, sharing bathrooms and kitchen facilities.
African Americans and Hispanic Americans are more likely to have the bacteria than whites and Asian Americans.

It is important to distinguish between ulcers caused by H pylori and those caused by medications only, because the treatment is completely different.

Ulcers can be linked with other medical conditions.

People who worry excessively are usually thought to have a condition called generalized anxiety disorder. This disorder has been linked with peptic ulcers.
A rare condition called Zollinger-Ellison syndrome causes peptic ulcers as well as tumors in the pancreas and duodenum.