The Etiological Factors of Duodenal and Gastric Ulcers

1.1 Background Peptic ulcer disease (PUD) had a tremendous effect on morbidity and mortality until the last decades of the 20th century. Development of new effective and potent acid suppressants and the discovery of Helicobacter pylori (H. pylori) are two important steps that caused a reduction in the prevalence of peptic ulcer. With the discovery of H. pylori, causes, pathogenesis and treatment of PUD have been defined again in the last 25 years. However, this condition continues to be an important clinical issue because of common use of nonsteroidal anti-inflammatory drugs (NSAID) and acetylsalicylic acid at low doses. The rare but increasingly problematic issue is H pylori-negative and NSAID-negative ulcers (1). Despite progress in diagnosis and treatment, peptic ulcer disease (PUD) remains a common reason for hospitalization and operation (2). Peptic ulcer disease (PUD) affects 10% of the world population. Helicobacter pylori infection and the use of a nonsteroidal anti-inflammatory drug (NSAID) are the principal factors associated with PUD (3). The declining global prevalence of peptic ulcer disease (PUD) might be because of the decreasing prevalence of Helicobacter pylori (Hp) infection (4). The decreasing prevalence of H. pylori could lead to a relative increase in the number of patients with this NSAID associated and idiopathic peptic ulcer disease (IPUD (5). Another view is that incidence of peptic ulcers decreased and an increasing proportion was related to NSAID and the Mortality was high (6). It is also known that the incidence of idiopathic peptic ulcer disease has increased (7,8). H pylori infection causes both gastric and duodenal ulcers (35-27). Current data shows that H pylori infection plays a major role in peptic ulcer disease and non-ulcer dyspepsia (9,10). Apart from these diseases, H pylori are thought to play a role in the etiology of atrophic gastritis, gastric adenocarcinoma and lymphoma. In our country, H. pylori prevalence remains an important health problem (11). The aim of this study is to determine the etiology of patients with duodenal and gastric ulcers.