Definition
- Peptic ulcer disease (acid-peptic disease) is ulceration of the gastric or duodenal mucosa by acid and pepsin, from decreased mucosal defense, acid hypersecretion, or infection.
- Ulcers occur far more often in the duodenum than in the stomach.
Diminished Mucosal Barrier
- Mucosal defense is provided by a mucus gel layer: mucin, phospholipid, electrolytes (mainly HCO3−) and water.
- It separates bicarbonate-rich epithelial secretion from acidic gastric content, keeping epithelial pH alkaline.
Mucus gel layerabout 0.2 mm thick
- Acid and pepsin cause ulceration when mucus or bicarbonate secretion is impaired, or the mucosal coat is mechanically damaged.
Hypersecretion of Acid
- Gastric acid secretion rises with chronic stress and spicy food, summarized as "hurry, worry, and curry."