Pathogenesis of gastric ulcer.

The cause of gastric ulcer is still poorly understood, even though a certain number of pathophysiologic abnormalities have been described in subgroups of gastric ulcer patients. It is not known whether these abnormalities lead to ulceration or occur as a result of ulcers. Environmental factors, such as aspirin intake or stressful life events, may be related to gastric ulcer in some patients. The main pathophysiologic events (dismotility, prostaglandin formation, alteration in gastric mucosal barrier and blood flow, impaired gastric secretions), and the environmental factors involved in the development of gastric ulcer (cigarette smoking, alcohol consumption, drug ingestion, psychologic stress, infectious agents) are reviewed in this paper. Knowledge about the natural history of gastric ulcer has been increased by the availability of fiberoptic endoscopy and by controlled clinical trials, but ulcer pathogenesis still remains obscure, and perhaps multifactorial.