Chronic peptic ulcers

Etiology: 1. Genetic and blood groups: Blood group O three times common than other groups.

2. Neurogenic: stress and anxiety through Vagus nerve.

3. Endocrine: There are specific endocrine disorders which may be associated with severe or intractable ulceration.

a) Zollinger - ellison syndrome.

b) Multiple adenoma syndrome.

c) Hyperparathyroidism.

4. Infection: Helicobacter Pylori.

5. Accessory causes: inadequate mastications, alcohol, irregular meals, smoking, vitamin deficiency.

Pathology:

• Occurs in alkaline mucosa.
• Invades muscle coats.
• Fibrosis from recurrent ulcers causes deformities.
• Nearly always situated in first part.
• Anterior ulcer carries risk of perforation while posterior ulcer may cause hemorrhage due to erosion of gastroduodenal artery.