“Aggressive” and “Protective” Factors in the Pathogenesis of Peptic Ulcer Disease

Abstract

A popular model of peptic ulcer pathogenesis depicts the disease as arising from an imbalance in the equilibrium that normally exists between the stomach’s “protective” barriers and “aggressive” luminal factors such as acid, pepsin, refluxed bile salts and ingested drugs. Clearly such aggressive factors are important but whether or not they instigate gastroduodenal damage remains controversial. We know acid and pepsin outputs are within the normal range in the majority of ulcer patients and non-steroidal anti-inflammatory drugs, while being important, are only relevant to a proportion of the total ulcer population. The obvious implication is that patients with peptic ulcer disease have abnormal mucosal resistance or defence to damaging luminal factors.