Peptic ulcer disease

Duodenal ulcer and gastric ulcer are often grouped together as peptic ulcers. The term 'peptic ulcer' refers to an ulcer in the lower oesophagus, stomach or duodenum. Ulcers in the stomach or duodenum may be acute or chronic; both penetrate the muscularis mucosae but the acute ulcer shows no evidence of fibrosis. Erosions do not penetrate the muscularis mucosae.

When the normal balance is upset between the factors which promote mucosal injury (gastric acid, pepsin, bile acids and ingested substances) and those that protect the mucosa (intact epithelium, mucus lining, bicarbonate secretion), peptic ulceration can occur. The development of ulceration may be mechanical, chemical, infectious or ischaemic in nature. It is thought that in some patients decreased pyloric sphincter pressure may permit the reflux of duodenal material into the stomach; the presence of such material disrupts the gastric mucosal barrier, exposing it to acid. Subsequent histamine release leads to oedema and mucosal erosion.

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