What is the Most Common Cause of Stomach Ulcers?

When the protective mechanisms of the gut are disrupted, stomach ulcers are formed. Undoubtedly, it takes multiple insults for the symptoms like abdominal pain, vomiting, bloody stool, or vomit to occur. But if the following changes continue frequently and go unchecked, then the formation of a gastric ulcer is inevitable – in worse case scenarios deeper gut layers may also be eroded, and full-blown diseases like IBD, IBS, and GERD can also occur. 

H. Pylori Bacteria 

One of the most common causes of peptic ulcer is infection with H. Pylori. It is a gut bacteria that specifically attacks the stomach’s epithelial cells. The bacteria release specialized proteins to penetrate the epithelial cells and mount an inflammatory response by releasing chemoattractants that cause migration of macrophages and neutrophils. This inflammatory response is a double-edged sword since it destroys the bacteria but also lyses the necrotic cells of the gut wall – thus weakening the protective submucosal layer. 

When this weakened layer comes in contact with toxins released by H. pylori, ulceration occurs. To make matters worse, H. Pylori releases urease, an enzyme that converts urea into ammonia and carbon dioxide. Ammonia neutralizes the hydrochloric acid in the stomach; further diminishing the gut’s protective mechanisms and easily forming ulcers. A simple urea breath test or stool sample can identify the presence of H. Pylori that can be eradicated by a short course of antibiotics and proton pump inhibitors to prevent severe ulcerations. 

Prolonged or Unprescribed Use of Non-steroidal Anti-Inflammatory Drugs (NSAIDs)

Aspirin and Ibuprofen are NSAIDs. The method of action of these drugs is inhibiting the pathways that protect the gut mucosa – like increasing mucin and bicarbonate production, increasing blood flow, and the regeneration of epithelium. Taking both the drugs, especially longer than the recommended dose, is a lethal combination that makes gastritis and stomach ulcers inevitable. 

Smoking 

Nicotine reduces blood flow to the gut through vasoconstriction of the blood vessels. Decreased blood supply reduces the amount of oxygen that reaches the gut, hence hindering effective peristalsis. This accounts for gastritis, acute gastropathy, as well as decreased mucin and bicarbonate production that causes ulceration, as discussed later. 

Stress 

Stress-induced splanchnic vasoconstriction disrupts the blood flow and motility within the gut. Both environmental and physiological stress cause stomach ulcers. Severe physiological stress activates the flight or fight response that reduces blood supply to the gut to direct better blood flow to the heart and the musculoskeletal system. Whereas direct injury can cause stress ulcers and Cushing ulcers. Stress ulcers are seen in severely ill, debilitated patients with shock and sepsis. Curling ulcers are seen in the stomach, duodenum, and esophagus due to an intracranial disease that disrupts the brain-gut axis. Yeh underlying pathogenesis is attributed to the local ischemia that occurs due to prolonged periods of stress, thus, causing frequent ulceration even afternoon minimal insults. 

Alcohol 

Alcohol is a harsh chemical that disrupts the mucosal lining of the stomach. Chronic alcoholism also exacerbates the function of the liver. The latter is responsible for protein digestion and emulsification of fats. Once these secretions are hampered, gut emptying is slowed down. This makes the gut an ideal breeding ground for bacteria. Additionally, the frequent vomiting and retching associated with alcohol abuse can weaken the gut wall – causing ulcers in the stomach and Mallory-Weiss tears in the esophagus. Frequent alcohol intake also hampers faster healing of already existing ulcers. 

Reduced Mucin and Bicarbonate Secretion 

Mucin is secreted frequently by the stomach’s foveolar cells for an even and abundant layer of mucus that prevents direct contact of gut contents as well as helps in lubrication during peristaltic movements of the gut. 

The gastric acid pH is close to 1, while the blood pH is normally around 7.4. This highly acidic pH kills bacteria and is buffered by bicarbonate to protect the following gut cavities like the duodenum and jejunum where the mucous protective barriers and rugae are significantly reduced. Thus, decreased mucin production and bicarbonate secretion strips away the protective barrier over the more sensitive mucosa causing ulceration and erosions. 

In conclusion, understanding the physiological changes that occur through specific drugs and foods can help develop a lifestyle and awareness that prevents the formation of peptic ulcers.

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