Acidpepsin versus mucosal resistance

An ulcer forms when there is an imbalance between aggressive factors, i.e. from the digestive power of gastric acid and pepsin, and defensive factors, i.e. the ability of the gastric and duodenal mucosa to resist this digestive power. This mucosal resistance constitutes the gastric mucosal barrier. Ulcers occur only in the presence of acid and pepsin; they are never found in achlorhydric patients such as those with pernicious anaemia. On the other hand, severe intractable peptic ulceration nearly always occurs in patients with ZollingerEllison syndrome, which is characterised by very high acid secretion.

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