Pathogenetic factors in erosive gastritis.

Under physiologic conditions, luminal acid and pepsin are absolute requirements in the development of erosive gastritis and ulceration. Even the injurious effects of most drugs are potentiated by acid and pepsin. Although the importance of luminal acid has long been recognized, only in the last 10 years has evidence accrued showing the detrimental effects of tissue acidosis in producing injury to the gastric mucosa. It now seems clear that by whatever means it is produced, e.g., through reduced mucosal blood flow, metabolic or respiratory acidosis, or inhibition of acid secretion with subsequent decreased "alkaline tide," tissue acidosis plays a profound role in the pathogenesis of erosive gastritis and ulceration. The gastric mucosal barrier is now recognized as the anatomic integrity of the surface epithelium, rather than as an ethereal physiologic barrier. This barrier is maintained as an intact layer under physiologic conditions by a newly described rapid repair process called restitution.