Injury factors of peptic ulcer
1, gastric acid and pepsin
All peptic ulcers occur in the acidic gastric juice bath in the organization of the site, which is its common characteristics. So people will think that the chemical stimulation on the occurrence of ulcers plays an important role. Animal experiments also proved that under the action of high acid can produce ulcers, regardless of continuous infusion of acidic solution using the method Abdominal or gastric acid secretion with continued excitement methods (such as implantable containing histamine beeswax). However, to go through a long period prior to ulcer formation of high concentrations of the role of acidic solution phase.
Most of duodenal ulcer patients have excessive gastric acid secretion. But this does not mean that simply because of ulcers caused by excessive gastric acid secretion. Levin, etc. have been observed in the amount of gastric acid secretion in patients with duodenal ulcer, duodenal ulcer were significantly higher than the average amount of gastric acid secretion. But on the other hand, the amount of gastric acid secretion in patients with gastric ulcer, but also lower than normal.
“No acid, no ulcer that is” (noacid, noulcer) commonplace phrase, then, had been the first by Schwartz (1910) propose, it seems still quite justified. Although the lack of acid has been reported in patients with peptic ulcer is seen, but many data indicate that peptic ulcer is basically not occur in a state of lack of acid in recent years has reported, free hydrochloric acid is still a major factor in ulcer formation, unless the maximal acid row volume (MAO)> 12mmol / h, or duodenal ulcer occurred Buzhi Yu.
Pepsin is a protein digestive enzyme, its ulcer formation also has an important role. Probably will not happen without pepsin peptic ulcer. However, the role of pepsin-induced ulcers than what hydrochloric acid. Diminished when the pH value of gastric juice increased the activity of pepsin and make it ineffective. Pepsin pepsinogen precursor substances, which began in the pH5 below into pepsin. Pepsin in pH1. 8-3. 5 between the best activity. As the hydrochloric acid pepsinogen need to be activated only after the play, together with the hydrochloric acid-induced ulcers of their role, and therefore the presence of gastric acid is the primary factor in the formation of ulcers.
Second, drug-induced factors
In addition to the above gastric acid and pepsin in addition, some drugs also has the role of induced ulcers. Grossman was reported in patients treated with aspirin, the incidence of gastric ulcer as the control group 3 times. Abuse of aspirin areas (such as Australia), increased the incidence of gastric ulcer, but the relationship between aspirin and duodenal ulcer is unclear.
Glucocorticoids and non-steroidal anti-inflammatory drugs are considered with the pathogenesis of peptic ulcer.
3, Helicobacter pylori (Hp)
Hp in the pathogenesis of DU occupy a certain position, which is recognized by all countries gastroenterology scientists, and beyond doubt. However, in recent years, scholars in the prevalence of gastrointestinal diseases with “no Hp have no ulcer” in the new argument, they believe DU is an infectious and transmitted diseases. Their main based on DU and Hp is closely related to, Hp infection in the disease detection rate of the highest, reaching 95% 1 100%, and after eradication of Hp to prevent recurrence of DU.
However, based on current information, there is insufficient direct evidence, certainly HP is a DU pathogens, but also not sure DU is an infection of the disease. There are the following facts:
1. If Hp is the DU pathogens, how to explain people in a number of Hp infection does not suffer from DU?
2. If Hp is the DU pathogens, how to explain the crowd at the Hp infection between patients with DU in the medical statistically that most of the gap. For example, in our DU patients had a significant male dominance, the peak prevalence in the 20-50 years old, but the gender distribution of Hp infection is no different, and the highest prevalence of older persons.
3. If Hp is the DU pathogens, why is not the role of Hp kill H2 receptor antagonists can cure DU?
4. If Hp is the DU pathogens, why some of DU is the Hp-negative? DU does have some unusual patients with Hp infection does not exist.
In short is usually caused by peptic ulcer disease, including environmental factors, work load, genetic factors, microbial factors, chemical factors, or even excessive smoke cigarettes as well as other relevant factors, or a combination of these factors. Hp what factors in these complex occupies what position, but also need to be more in-depth research.
4, bile
Gastric emptying in patients with gastric ulcer often slow and pyloric sphincter dysfunction. Pyloric relaxation prone to cause an increase of duodenal bile reflux. Known as the detergent bile salts, bile reflux is not only soluble adhesive on the mucous membrane of the mucus, high concentrations of bile salts, hemolytic lecithin can also be toxic to the cell membrane and directly damage gastric mucosal barrier, the authors have that its results can lead to the formation of ulcers.
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