Welcome back, everyone, after our short break for Thanskgiving (for those of us in the states). Everyone (well, almost everyone) knows that ulcers are associated with H. pylori. But how often? And what else is involved? First of all: the cause of peptic ulcer disease (PUD) is an imbalance between mucosal defenses and mucosal damage. Same thing that causes chronic gastritis! Its weird that some people get only chronic gastritis while others get PUD. Nobody knows why, exactly. The two big causes of PUD are H. pylori and NSAID (non-steroidal anti-inflammatory drug) use. Both cause mucosal damage and inhibit mucosal defenses. Heres a weird thing: More than 70% of people with PUD are infected by H. pylori - but only 20% of patients with H. pylori get PUD. This probably has something to do with the strain of H. pylori involved and the hosts defenses against the bug. Still. Chronic NSAID use causes ulcers by direct chemical irritation, and also by inhibiting synthesis of prostaglandins (which you need for mucosal protection). Ulcers are usually accompanied by excessive acid production. This can be caused by a bunch of different things, including: H. pylori, parietal cell hyperplasia, excessive acid secretion, and impaired inhibition of stimulatory responses (like gastrin release). Treatment of ulcers usually entails an antibiotic (for those patients with H. pylori infection, which includes most patients) and an acid neutralizer (like a proton pump inhibitor). Surgery (to take out gastrin-producing cells and remove part of the vagus) is rarely done these days, except to repair a bleeding ulcer.
Posted on: Tue, 03 Dec 2013 07:56:58 +0000
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