The upper or proximal gastrointestinal (GI) system includes esophagus, stomach, duodenum and jejunum. Middle GI system is formed by small intestine, while distal GI system includes large colon, sigmoid colon and anus. The stomach continues as a duodenum. The passage of food within the stomach is transmitted to duodenum through a small opening known as pylorus. Pylorus is formed by thick layers of smooth muscles. Sustained and prolonged contraction of pylorus closes the passage food from stomach to duodenum after meal. The food is grinded and mixed within the stomach for duration of 1 to 3 hours. The digestive procedures includes gastric juice and high concentration of acid. The gastric juice contains hydrochloric acid and maintains low pH. The acidic juice in few individuals damages mucosal epithelium of stomach and duodenum. The damaged mucosal layer some time forms non healing breech or cracks in mucosa known as ulcer. The persistent and repeated regurgitation of stomach food mix with high acid gastric juice causes esophageal ulcer. The acidic gastric juice can trigger the formation of ulcer within the mucosa of esophagus, stomach and duodenum.
The ulcer is known as peptic ulcer when gastric acidic juice causes ulcers within mucosa of stomach, esophagus and duodenum. The duodenal ulcer is observed as single or multiple ulcer localized in duodenum only.
What Causes Duodenal Ulcer?
Duodenal Ulcer Caused Due to H. Pylori Infection
Bacterial infection such as gastroenteritis is often caused by H.Pylori bacteria. Infection of stomach and duodenum causes inflammation of mucosa of stomach and duodenum. During the phase of healing of inflammation several mucosal epithelial tissue does not heal into normal endothelial cells. Thus, following Helicobacter pylori (H. pylori) infection the scarred and weak inflamed mucosal epithelium ends up with several ulcer . The ulcers are observed in stomach, duodenum or both. The isolated ulcer localized in stomach is known as gastric ulcer and ulcer when observed in duodenum is known as duodenal ulcer. The Helicobacter pylori (H. pylori) bacterial infection often causes multiple duodenal ulcers.
Duodenal Ulcer Caused Due to Zollinger-Ellison Syndrome
Zollinger-Ellison syndrome (ZE) is a rare disease. The Zollinger-Ellison syndrome (ZE) is caused by a single multiple tumor that secretes hormone gastrin. The tumor grows within pancreas or duodenum. The hormone secreted by tumor is known as gastrin. Hormone gastrin stimulates stomach mucosal cells resulting in increased acid synthesis. The gastrin triggers substantial increase of acid within gastric juice. The gastric juice in increased volume and lower pH triggers formation of several ulcers in duodenum and stomach.
Alcohol Consumption Causes Duodenal Ulcer
Social drinking or occasional drinking of alcohol does not cause duodenal ulcer. Heavy regular drinking may cause duodenal ulcer. The published scientific articles suggest among the alcohol red wine is less harmful to mucosal epithelial cells.1 Alcohol causes microbiological changes in mucosal cell making it vulnerable to bacterial infections followed by mild to severe cell damage followed by ulcer formation.2 Persistent presence of alcohol in duodenum weakens the cell margin and exposes mucosal cell to harmful effects of acids floating in gastric juice.
Chronic Smoking Causes Duodenal Ulcer-
Smoking causes decreased oxygenation of mucosal cells and gene mutation. The mucosal cells thus become weak, and immune impairment resulting from chronic smoking interferes with recovery of damage cell. Duodenal ulcer is often seen in patient who are chain smoker.
Duodenal Ulcer Caused Due to Stress and Anxiety –
The reason why stress or anxiety cause gastric or duodenal ulcer is yet unknown3. But published scientific articles has suggested that gastric and duodenal ulcers are observed more often in patient who suffer with anxiety or stress.4
Prolonged Consumption of NSAIDs Can Cause Duodenal Ulcer-
Anti-inflammatory medications such as Motrin, Aspirin and Naproxen are also known as non-steroidal anti-inflammatory drugs or NSAIDs. NSAIDs inhibits the action of cyclooxygenase enzyme resulting in low concentration of intracellular prostaglandin. The effective ulcer healing was observed when Research papers published suggests Proton pump inhibitors increases cellular concentration of COX1 and Cox2 enzyme resulting in rapid ulcer healing.5 NSAIDs are widely prescribed in elderly to treat arthritis and pain. NSAIDs inhibits activities of enzyme COX 1 and COX 2 and results in decreased secretion of prostaglandin. Lack of prostaglandin alters the mucosal cell function and resistance, which is necessary to protect mucosal cells from harmful effects of acid and H. Pylori infection.6
Note: The most important steps in diagnosis of stomach ulcer is to consult a gastroenterologist. The clinical examination, interpretation of finding of examination and analysis of test results has to be evaluated by expert in the field of gastroenterology system. Our recommendation is, if you suffer with any of similar symptoms then, consult gastroenterologist as soon as possible.
- What is Duodenal Ulcer: Risk Factors, Complications, Prevention, Home Remedies
- Diagnosis of Duodenal Ulcer: Symptoms, Test
- Diet for Duodenal Ulcer Patients
Alcoholic beverages and gastric epithelial cell viability: effect on oxidative stress-induced damage.
Loguercio C1, Tuccillo C, Federico A, Fogliano V, Del Vecchio Blanco C, Romano M.
J Physiol Pharmacol. 2009 Dec;60 Suppl 7:87-92.
Chronic alcohol exposure renders epithelial cells vulnerable to bacterial infection.
Wood S1, Pithadia R, Rehman T, Zhang L, Plichta J, Radek KA, Forsyth C, Keshavarzian A, Shafikhani SH. PLoS One. 2013;8(1):e54646.
A link between physician-diagnosed ulcer and anxiety disorders among adults.
Goodwin RD1, Talley NJ, Hotopf M, Cowles RA, Galea S, Jacobi F.
Ann Epidemiol. 2013 Apr;23(4):189-92.
Generalized anxiety disorder and peptic ulcer disease among adults in the United States.
Goodwin RD1, Stein MB., Psychosom Med. 2002 Nov-Dec;64(6):862-6.
Cyclo-oxygenase-2 expression and prostaglandin E2 production in experimental chronic gastric ulcer healing. Poonam D1, Vinay CS, Gautam P., Eur J Pharmacol. 2005 Sep 20;519(3):277-84.
Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) Induced Dyspepsia.
Yap PR, Goh KL1. Curr Pharm Des. 2015;21(35):5073-81.