How Ulcers Form
Ulcers, specifically stomach ulcers (also known as peptic ulcers) have several mechanisms through which they can form. Below, we will examine each of these mechanisms and how they can form.
Helicobacter Pylori – The #1 Reason Ulcers Form
H pylori is an infectious bacterium which colonizes the digestive system. Once a person is infected, it can live and reproduce in the stomach and intestine for a person’s entire lifetime.
The relationship between this infection and ulcers is not well understood. In North America and Europe this bacterial infection is highly correlated with ulcer incidence. Additionally, treating the infection via a standardized treatment like triple therapy has a high success rate of not only defeating the infection but reversing the ulcer as well.
However, this may not be the case in all populations. For example in developing nations on Africa, nearly everyone is infected with H pylori but ulcers are less common there than they are in North America (1). This effect in part is created due to differences in lifespan, as the life expectancy in many African countries is lower than in other parts of the world. However, lifespan differences are not enough and suggest that there may be other factors at play in ulcer formation (1).
We know that H pylori infections do result in increased occurrences of gastritis, or inflammation of the stomach, even in Africa (1). However, the exact mechanism which this inflammation translates into ulceration is not fully understood.
It is theorized that H pylori somehow weakens the protective lining of the stomach and duodenum (the early portion of the small intestine that is very susceptible to ulcers). This in turn leaves the tissues vulnerable to stomach acid and digestive enzymes, leading to ulceration. The enzyme pepsin is thought to play a major role as well; pepsin is a digestive enzyme which helps break down proteins and it is only found in the stomach.
Additionally, there are various digestive enzymes such as trypsin and chymotrypsin which are only found in the duodenum, which also break down proteins. The duodenum is the organ where peptic ulcers are most likely to occur, so it makes these enzymes a likely contributor for ulcer formation.
In short, in the right conditions, H pylori makes the stomach and duodenum likely to form ulcers, but the exact mechanism through which H pylori works is still the subject of research.
NSAIDs – Another Way Ulcers Form
Non-steroidal Anti-Inflammatory Drugs, or NSAIDs, are responsible for the majority of the remaining minority of ulcers. Allow me to clarify:
- Most ulcers form as the result of H pylori infection (various estimates suggest this is anywhere from 65-90% of ulcers in modern countries)
- Out of the ulcers that do not form from H pylori infection, most of those form from NSAIDs
- A very small minority of ulcers from very rare conditions or circumstances
NSAIDs include aspirin, ibuprofen, naproxen, among others. These are all anti-inflammatory drugs that have wide-ranging effects upon the body. These are often used in osteoarthritis, rheumatoid arthritis, and other joint pains.
The chronic use of these medications seems to inhibit the activity of cells responsible for producing the protective mucus that lines the stomach. When the activity of these cells wanes, the sensitive tissue underneath becomes exposed to stomach acid. This is another way that ulcers are formed.
Rare Ways Ulcers are Formed
Ulcers can form under cases of extreme physical stress. Not just any type of stress will due, but rather something along the lines of an injury that has taken a person to the brink of death. For example, when someone is injured and rushed to the intensive-care unit of a hospital and put on a ventilator, their risk of a stress ulcer is fairly high. The usage of a ventilator in particular is strongly associated with stress ulcers. Fortunately, most hospitals in civilized nations practice stress ulcer prophylaxis – that is they give medications to prevent ulcers from forming to high-risk patients.
Some extremely rare genetic mutations may cause a person to get ulcers as rare, such as certain mutations which result in significantly increased stomach acid production.
How Ulcers Are Formed Conclusion
Nearly every ulcer in modernized nations is the result of H pylori infection. To read more, visit this article on H pylori testing, which details the variety of diagnostic tests used to check for H pylori.
References
1. Holcombe, C. Helicobacter pylori: the African enigma. Gut. 1992 Apr;33(4):429-31.
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