H.pylori peptic ulcer disease pathophysiology

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Yamuna Kondapally, M.B.B.S[2]

Pathophysiology

• H.pylori is closely associated with both duodenal and gastric ulcers.
• The estimated lifetime risk for the development of peptic ulcer disease is 10-20%, in patients with H.pylori infection.
• H.pylori can be diagnosed in 60-100% of gastric ulcer patients and 90-100% in duodenal ulcer patients.

Duodenal Ulceration

• The patients with higher gastric acid secretion have increased risk of developing duodenal ulcers compared to normal, healthy individuals.
• The most important requirements for the development of duodenal ulceration are:

• Gastric metaplasia in the proximal duodenum
• Active chronic duodenitis

Pathogenesis

Gastric metaplasia

• H.pylori causes hypergastrinemia and increased sensitivity to gastrin.
• Gastric metaplasia (the presence of gastric-type mucus secreting cells in the surface epithelium of the duodenum) occurs as a part of host defence mechanism to protect against the repeated injury caused by arrival of unneutralized acid in the first part of duodenum.