Fast Five Quiz: Review Key Aspects of Peptic Ulcer Disease

Jamie Shalkow, MD

Disclosures

May 11, 2017

Although the idea was initially controversial, most evidence now supports the assertion that H pylori and NSAIDs are synergistic with respect to the development of peptic ulcer disease. A meta-analysis found that H pylori eradication in NSAID-naive users before the initiation of NSAIDs was associated with a decrease in peptic ulcers.

Evidence that tobacco use is a risk factor for duodenal ulcers is not conclusive. Support for a pathogenic role for smoking comes from the finding that smoking may accelerate gastric emptying and decrease pancreatic bicarbonate production. However, studies have produced contradictory findings. Ethanol is known to cause gastric mucosal irritation and nonspecific gastritis. Evidence that consumption of alcohol is a risk factor for duodenal ulcer is inconclusive. A prospective study of more than 47,000 men with duodenal ulcer did not find an association between alcohol intake and duodenal ulcer. Little evidence suggests that caffeine intake is associated with an increased risk for duodenal ulcers.

Seasonal changes and climate extremes may also affect gastric mucosa and cause damage to the gastric mucosa and its barrier function. In an extremely cold climate, Yuan and colleagues noted a significantly lower expression of heat shock protein 70 as well as decreased mucosal thickness in the gastric antrum of patients with peptic ulcer disease who were at high risk for bleeding compared with those at low risk for bleeding.

More than 20% of patients have a family history of duodenal ulcers. In addition, weak associations have been observed between duodenal ulcers and blood type O. Furthermore, patients who do not secrete ABO antigens in their saliva and gastric juices are known to be at higher risk. The reason for these apparent genetic associations is unclear.

Although less common, other risk factors for duodenal ulcer include Zollinger-Ellison syndrome, previous gastric surgery, crack-cocaine and methamphetamine abuse, use of steroids and other drugs, infectious agents, and stress ulcers in severely ill patients.

For more on the etiology of PUD, read here.

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