Peptic Ulcer

Peptic ulcers are erosive lesions of the gastric or duodenal lining, most commonly caused by Helicobacter pylori infection. This Gram-negative, helical bacterium has adapted to survive the stomach’s acidic environment by producing urease, which converts urea into ammonia and carbon dioxide. The ammonia neutralizes gastric acid in the bacterium’s immediate environment, allowing colonization of the gastric mucosa. H. pylori attaches to mucus-secreting epithelial cells, penetrates the mucus barrier, and initiates a cascade of pathogenic processes.

Virulence Factors and Mucosal Damage

The pathogenicity of H. pylori is mediated by a set of virulence factors. Urease is central to acid neutralization, while adhesins facilitate binding to epithelial surfaces. Two major exotoxins—VacA and CagA—amplify tissue damage. VacA induces apoptosis in epithelial cells, while CagA activates pro-inflammatory signaling pathways, notably through cytokine release and recruitment of neutrophils. These responses lead to chronic inflammation, erosion of the protective mucus layer, reduction of bicarbonate secretion and direct cellular injury. Over time, the exposure of epithelial surfaces to gastric acid and pepsin results in the formation of ulcers, which may penetrate deeper tissue layers and damage blood vessels, leading to gastrointestinal bleeding.

Transmission and Epidemiology

H. pylori is typically acquired during childhood, likely through oral transmission. It is rarely associated with common vectors such as food or animals, suggesting that person-to-person spread, especially within families, is the primary mode of infection. Prevalence is significantly higher in developing countries, correlating with poor sanitation and crowded living conditions. Chronic H. pylori infections are also associated with increased risk of gastric malignancies, including MALT (Mucosa-Associated Lymphoid Tissue) lymphomas and gastric carcinoma. These outcomes stem from persistent inflammation and the resulting disruption of mucosal immunity and cellular regulation.

Clinical Presentation and Complications

Ulcers often present with abdominal pain and may lead to serious complications such as gastrointestinal bleeding, perforation, and obstruction. Vomiting of coffee-ground material, weight loss, and black, tarry stools may indicate advanced disease. Untreated ulcers, particularly those complicated by vascular involvement or mucosal perforation, represent medical emergencies requiring prompt intervention.