Review of Duodenal and Gastric Ulcer.

Abstract : Duodenal and gastric ulcer are chronic often recurring conditions that in the past were grouped together as peptic ulcer. Many diverse environmental and genetic factors, which create an imbalance between secretion of acid and pepsin by by the stomach and the resistance of the gastrointestinal mucosa may lead to the development of a duodenal or gastric ulcer. Incidence trends and risk factors for these two diseases are different. Reported mortality and hospitalization rates declined markedly for duodenal ulcer from 1970-78, but remained relatively stable for gastric ulcer over the same time period. Recent changes in treatment and diagnosis may account for much of this decline. Several environmental factors associated with duodenal or gastric ulcer have been identified. The principal risk factor for duodenal ulcer is cigarette smoking. Less certain associations with diet, emotional stress, coffee consumption, and occupation have also been reported. Risk of gastric ulcer is also increased by cigarette smoking. Aspirin use, however, is the strongest reported rick factor for gastric ulcer. (RR = 6.5) uncertain associations between gastric ulcer and alcohol consumption have also been reported. Separate familial aggregation of duodenal and gastric ulcer indicates that genetic mechanisms leading to the development of these diseases are also distinct. Inheritance patterns for hyperpepsinogenemia I, the Zollinger-Ellison syndrome and several other genetic conditions predisposing to the development of either duodenal or gastric ulcer have ben described.