An ulcer is defined as a breach in the mucosa of the alimentary tract, which extends through the muscularis mucosae into the submucosa or deeper. Although ulcers may occur anywhere in the alimentary tract, none are as prevalent as the peptic ulcers that occur in the duodenum and stomach. Acute gastric ulcers may also appear under conditions of severe systemic stress.



Peptic ulcers

Peptic ulcers are chronic , most often solitary, lesions that occur in any portion of the gastrointestinal tract exposed to the aggressive action of acid peptic juices. Peptic ulcers are usually solitary lesions less than 4 cm in diameter, located in the following sites, in order of decreasing frequency:

Duodenum, first portion

Stomach, usually antrum

At the gastroesophageal junction, in the setting of gastroesophageal reflux

Within the margins of a gastrojejunostromy

In the duodenum,stomach, or jejunum of patients with Zollinger-Ellison syndrome.

Within or adjacent to a Meckel diverticulum that contains ectopic gastric mucosa

In the United States, approximately 4 million people have peptic ulcers (duodenal and gasteric), and 350,000 new cases are diagnosed each year. Around 100,000 patients are hospitalized yearly , and about 3000 people die each year as a result of peptic ulcer disease. The lifetime likelihood of developing a peptic ulcer is about 10% for American men and 4% for women. Visit for

Peptic ulcers are remitting , relapsing lesions that are most often diagnosed in middle aged to older aged, but they may first become evident in young adult life. They often appear without obvious precipitating influences and may then after a periof of weeks to months of active disease, heal with or without therapy. Even with healing however, the propensity to develop peptic ulcers remains in part because of the propensity for recurrent infections with H.pylori. The male to female ration for duodenal ulcers is about 3:1 and for gasteric ulcers about 1.5 to 2:1. Women are most often affected at or after menopause. For unknown reasons, there has been a significant decrease in the prevalence of duodenal ulcers over the past decades but little change in the prevalence of gastric ulcers.

Peptic ulcers appear to be produced by an imbalance between the gastroduodenal mucosal defense mechanisms and the damaging forces. Gastric acid and pepsin are requisite for all peptic ulcerations. Hyperacidity is not a prerequisite because only a minority of patients with duodenal ulcers have hyperacidity, and it is even less common in those with gastric ulcers. Gasric ulceration can rapidily occur when mucosal defenses fall, however as when mucosal blood flow drops gastric emptying is delayed or epithelial restitution is impaired.