The etiology and pathogenesis of gastric ulcer

The etiology and pathogenesis of peptic ulcer disease is so inseparably linked with each other that their separation is little justified and artificial. Studying the reasons and mechanisms of diseases development is impeded by the lack of adequate experimental models and, obviously, peptic ulcer disease should be referred to a purely human pathology.
The main factors involved in the development of peptic ulcers can be grouped as follows:
1. Disorders of regulation of activity of a stomach and duodenal ulcers:
a) nervous factors;
b) hormones in the endocrine glands (pituitary, adrenal gland, thyroid and parathyroid glands);
in) digestive hormones (gastrin, secretin);
g) biogenic amines (histamine, serotonin).
2. Morphological changes of the mucous membrane of the stomach and duodenum.
3. Poor circulation and mucous barrier in the gastroduodenal system.
4. Hereditary and constitutional factors.
5. The conditions of the external environment.

The presented data testify about the great variety of reasons and pathogenic mechanisms ulcers that at the existing level of knowledge does not allow to formulate a unitary theory of the development of this disease.
Every year in the literature there are still reports confirming the existence of two main forms ulcers - ulcers body of the stomach and piloroduodenalnoy zone. In both forms of pathogenetic factors remain the same, but when the plagues of the body of the stomach at the forefront are the violation of the structure of the mucosa of the stomach of a particular nature, trophic disorders, while at piloroduodenalnoy ulcers critical importance disorders regulation of secretory and motor functions of a stomach.
Disintegration in the cerebral cortex, resulting from the influence of different kinds of impulses, accompanied by a persistent increase in the activity of the hypothalamus, of wandering nerve and pituitary glands that produce a large number of ACTH. With increased vagal tone is impaired motor function of stomach, thus increasing the peristaltic activity and tone), steadily growing activity of acid-peptic factor. Is gradually forming "sour stomach with continuous high gastric secretion. Systematically, in connection with motor impairments in the gastro-duodenal the system is reset acid content into the duodenum, where alkaline (bicarbonate) secretion is not always sufficient to neutralize him.
A certain role is played by the adrenal cortex, the functional activity of which alone reduced, but is Hyper-reactivity with inadequate reaction and release of steroids in response to normal stimuli.
High gastric secretion is supported by the increased activity of histamine, a synthesis in which the lining of the stomach increases and inactivation decreases. Antral gastritis and duodenitis also promote maintenance of excessive activity obkladochnykh cells, as disrupted the process of the physiological regulation of gastric secretion, providing its intermittent nature (Fig. 24).

Fig. 24. The scheme of regulation of gastric digestion.
(+) - stimulation; (-) - braking; (?) estimated braking.

Place gastrin among pathogenetic factors remains unclear, though, obviously, it participates in the formation hyperplasia
obkladochnykh cells of gastric mucosa. Gradually created a pathological situation where constantly there is no correspondence between aggressive damaging properties gastric content, ritmichno coming into the duodenum, and protective capabilities of the mucous membrane (morphological changes - duodenitis, lack of alkaline secretion and others). In a certain period of time experiencing severe erosion and ulcers in the duodenal bulb, which don't heal and become chronic peptic ulcers.
When gastric ulcer is important qualitative and quantitative changes of the components of mucus, which facilitates the inverse diffusion of hydrogen ions, damaging the mucosa. Low functional activity of the adrenal cortex can affect trophic processes, cell regeneration of epithelial cells. It is possible that a certain role is played violations of anthro-duodenal motility, which are accompanied by reflux of duodenal contents mixed with gall into the stomach. No doubt that the formation of chronic ulcers are prerequisites for such transformation of acute gastroduodenal lesions. Many of these prerequisites are unclear and require further study and analysis.
Obviously, only the combined impact of all pathogenetic factors created a pathological situation causing steadfastly healing of ulcers in the gastro-duodenal zone. Apparently, one should agree with N. S. Molchanov (1968), which denies poliatilenglikole ulcerous disease in the proper sense of the word, and treats ulcer as a single nosological form, in which you can select individual clinical and pathogenetic variants: the plague of the body of the stomach, piloroduodenalnoy zone, combined form, etc.
We must not forget that there are combined form, and a duodenal ulcer is typically the primary disease, and then hyperplasia of the mucous membrane structural changes and atrophic its changes and their background, developing ulcers body of the stomach (Mangold, 1958; Aagard and others, 1959).
Predisposing factors (environment, constitutional factors, and so on) provide the background against which the action is implemented major factors involved in the formation.
C. X. Vasilenko and others (1970) suggest that in the development of peptic ulcer disease, in addition to relations aggressive damaging properties of gastric juice and the protective mechanisms of gastroduodenal system, not less important and the third factor is the speed healing of the defect, delay which contributes to the formation of chronic ulcers. The last still little studied gastroenterologists, especially in humans.
In the recent time there have been studies that support the view M. P. Konchalovsky and the Imperial family Lorie about the existence predyazvennoe state. So, L. N. Shirochenko (1971) showed that long before the formation of ulcers "niches" in the gastroduodenal zone is typical clinical picture of the disease in conjunction with distinctive discoordination secretion and motor function of stomach and pathological evacuation acid content into the duodenum. The author proposes to allocate functional phase of peptic ulcer.