GSE
What causes gastric / stomach ulcers?
What are the causes and risk factors of gastric / stomach ulcers?
What causes a stomach ulcer?
H. Pylori H. pylori is a common bacteria infecting about half of
world'spopulation, with higher prevalence in developing countries.
The bacteria H.
Pylori are responsible for ~75% of all gastric ulcers. burrowing into the stomach lining and
causing inflammatory damage. H. Pylori presence is normally
controlled by a sufficient acidity level in the stomach.
. H. pylori can survive in the harsh acidic environment
of the stomach because they produce the urease enzyme that promotes ammonia
production around them to neutralize stomach acid. However,
this study found that their glucose metabolism was irreversibly inhibited at
the normal healthy stomach acid pH of <3.5.
Nobel Prize recipient Marshall induced gastritis in
himself by consuming H. Pylori . He was then able to treat the gastritis using a 14 day dual therapy
with bismuth salts and
metronidazole . Marshall and Warren went on to show that antibiotics are
effective in the treatment of many cases of gastritis. In 1994, the Nation
Institutes of Health (USA) published an opinion stating that most recurrent
gastric ulcers were caused by H. pylori, and recommended that antibiotics be
included in the treatment regimen. Wikipedia
Bacteria usually enters the body via food and drink,
but may also be contacted through mouth-to-mouth contact
such as kissing. Researchers have found H. pylori
in the saliva of
some infected people.
Rapid urease test (RUT)
(Also called campylobacter-like organism (CLO) test). Used to diagnose the
presence of H. Pylori in a biopsy sample taken
from stomach's gastric mucosa at ulcer site during gastroscopy.
Cox-1 inhibiting NSAIDS (Non-steroidal
anti-inflammatory drugs)
Regular, excessive or prolonged use of
traditional (COX-2 and
COX-1 enzyme inhibiting) NSAIDs
is a well recognized cause of
peptic ulcers and gastritis (inflammation of the stomach lining).
Traditional NSAIDS include
aspirin (Beyer®),
ibuprofen (Motrin®,
Advil®), naproxen (Aleve®) ;
The more recent selective COX-2 enzyme inhibitors include Celebrex® and the
infamous rafecoxib (Vioxx®, recalled in 2004 after being responsible for an
estimated 60,000 deaths due
to heart problems). Traditional NSAIDs
(Not COX-2 selective)
inhibit the
COX-1 enzyme in the GI tract, reducing prostanoid
synthesis from arichidonic acids (AAs). In particular, reducing
prostacyclin (PGI2) and prostaglandin PGE2 with their protective effects for the stomach
lining mucosal cells (gastric
mucosa) can lead to erosion, ulceration, perforation and hemorrhage.
Prostaglandins prostacyclin (PGI2) and
PGE2 are crucial to reducing acid secretion by
gastric mucosa's parietal cells
Dini, 2017 ,
and maintaining healthy gastric mucosa by increasing blood flow to damage site
and increasing mucus secretion to better protect lining from stomach acid.
COX-1 inhibiting NSAIDs reduce prostaglandins PGI2 (prostacylin),
PGD2,
PGE2 PGF2α-,
and thromboxane TXA2 .
Chart of Specific Eicosonoid (including prostaglandins) Effects
• Risk increases in women and anyone older than 60.
Some NSAIDS are stronger COX-1 inhibitors than others.
NSAIDs Warning
Malignant tumor A malignant tumor causes about 4% of gastric ulcers
Risk factors
Risk factors for developing a stomach ulcer
• Stress
• Excess alcohol consumption. Alcohol has the potential to harm the stomach
lining by stimulating gastric juice production
• Family history of ulcers
• Smoking
• Use of corticosteroids.
•
Zollinger-Ellison syndrome
• Improper diet,
irregular or skipped meals.
Dietary factors causing stomach ulcers in pigs (mammals with one stomach,
like us) are:
Low protein / Low fiber diets.
Levels of wheat in excess of 55%.
Deficiencies of vitamin E or selenium.
Diets containing high levels of iron, copper or calcium
and/or low in zinc.
Diets with high levels of POLYUNSATURATED fats.
Diets based on skimmed milk.
Footnote: pig ulcers occur
at the top of the stomach and human ulcers toward the bottom.
• Chronic disorders such as liver disease, emphysema, rheumatoid
arthritis may increase vulnerability to ulcers
Note: Spicy food CANNOT CAUSE
stomach ulcers, but can aggravate an existing stomach ulcer.
Risk factors for serious complications, such as stomach lining perforation or bleeding ulcers
• The elderly and women;
• Having rheumatoid arthritis, severe systemic disease or previous history of
gastroduodenal bleeding;
• Using anti-thrombotic medication, corticosteroids, or high doses of
NSAIDs;
References
Drini M. (2017). Peptic ulcer disease and non-steroidal anti-inflammatory drugs. Australian
prescriber , 40 (3),
91-93. doi:10.18773/austprescr.2017.037
Link
