Physiological Adaptation Q 82
The client asks Nurse Annie the causes of peptic ulcer. Nurse Annie responds that recent research indicates that peptic ulcers are the result of which of the following:
A. Genetic defect in gastric mucosa
B. Stress
C. Diet high in fat
D. Helicobacter pylori infection
Correct Answer: D. Helicobacter pylori infection
Most peptic ulcers are caused by Helicobacter pylori which is a gram-negative bacterium. H. pylorus is a gram-negative bacillus that is found within the gastric epithelial cells. This bacterium is responsible for 90% of duodenal ulcers and 70% to 90% of gastric ulcers. H. pylori infection is more prevalent among those with lower socioeconomic status and is commonly acquired during childhood. The organism has a wide spectrum of virulence factors allowing it to adhere to and inflame the gastric mucosa. This results in hypochlorhydria or achlorhydria, leading to gastric ulceration.
Option A: Peptic ulcers are not genetic in nature. They occur when acid in the digestive mucosa eats away at the inner surface of the stomach or small intestine. Peptic ulcer disease (PUD) has various causes; however, Helicobacter pylori-associated PUD and NSAID-associated PUD account for the majority of the disease etiology.
Option B: Stress is not a cause of peptic ulcers. Nonsteroidal anti-inflammatory drugs use is the second most common cause of PUD after H. pylori infection. The secretion of prostaglandin normally protects the gastric mucosa. NSAIDs block prostaglandin synthesis by inhibiting COX-1 enzyme resulting in a decrease in gastric mucus and bicarbonate production and a decrease in mucosal blood flow.
Option C: Common causes of peptic ulcer include a bacteria (H. pylori), regular use of certain pain relievers, and use of certain medications along with NSAIDs. Apart from NSAIDs, corticosteroids, bisphosphonates, potassium chloride, steroids, and fluorouracil have been implicated in the etiology of PUD. Smoking also appears to play a role in duodenal ulcers, but the correlation is not linear. Alcohol can irritate the gastric mucosa and induce acidity.