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Hospital therapy. Etiology of gastric ulcer (most important)

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41. Etiology of gastric ulcer

Peptic ulcer (peptic ulcer) is a chronic, relapsing disease, clinically manifested by a functional pathology of the gastroduodenal zone, and morphologically - by a violation of the integrity of its mucous and submucosal layers, and therefore the ulcer always heals with the formation of a scar.

Etiology. The main etiological factor of peptic ulcer is the microbial expansion of HP on the surface of the epithelium of the stomach.

The significance of bacterial aggression in the etiology of the disease has been studied since 1983, when J. Warren and B. Marshall reported the discovery of a large number of S-spiral bacteria on the surface of the epithelium of the antrum of the stomach.

Helicobacteria are able to exist in an acidic environment due to the production of the urease enzyme, which converts urea (from the bloodstream) into ammonia and carbon dioxide. The products of enzymatic hydrolysis neutralize hydrochloric acid and create conditions for changing the pH of the environment around each bacterial cell, thus providing favorable conditions for the vital activity of microorganisms.

No less important in the development of peptic ulcers are neuropsychic effects, hereditary predisposition, infectious agents, alimentary errors and the intake of certain medications, and bad habits.

Popular among researchers are hereditary factors: the inertia of the main nervous processes, group-specific properties of blood, immunological and biochemical features, hereditary burden syndrome. In the occurrence of peptic ulcer, essential importance was attached to alimentary violations.

However, clinical and experimental studies conducted in the last two decades in most cases did not reveal the damaging effect of food products on the gastroduodenal mucosa. The prevalence of peptic ulcer disease among significant contingents of people with different dietary habits also testifies against the leading importance of nutritional factors. Disturbances in the rhythm and regularity of nutrition, long breaks between meals, untimely eating are essential for the occurrence of peptic ulcers. Researchers have expressed relatively conflicting views about the role of alcohol in ulcerogenesis. Alcohol is known to cause atrophic changes in the gastric mucosa. These observations are in conflict with the general concept of ulceration.

The role of medicinal effects in ulcerogenesis is being actively studied. The results of studies published in the literature and our own data indicate that non-steroidal anti-inflammatory drugs and glucocorticoid hormones have the most pronounced ulcerogenic properties.

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