Tuesday, 26 November 2013

Duodenal ulcers : The Risk factors

Duodenal ulcers, a type of peptic ulcer is defined as a condition of a localized tissue erosion in the lining  the duodenum as a result of bacteria Helicobacter pylori (H pylori) in most cases. According to the study by Department of Research, University Hospital, Basel, fasting gastrin and pepsinogen-I and -II concentrations were significantly higher in H pylori positive compared with H pylori negative subjects. Neither age nor sex affected basal gastrin and pepsinogen concentrations in H pylori negative subjects. Fasting gastrin, pepsinogen-I and -II concentrations in serum samples were similar in H pylori positive persons with no symptoms and those with duodenal ulcers suggesting that similar mechanisms are involved in increasing plasma concentrations of these variables in both populations. Hypergastrinaemia and hyperpepsinogenaemia are therefore probably secondary to active H pylori infection(1).
B.2. Risk factors
1. Psychosomatic factors
Life stress may modulate these impulses and in this way cause two types of gastrointestinal reactions. Psychophysiological reactions involve accentuations, inhibition or distortion of the pattern of function of gastrointestinal organs without changes in their structure. Psychosomatic reactions lead to morphological changes in the end organ, e.g. activation of peptic ulcer or ulcerative colitis(9).
2. Genetic predisposition, incorrect diet and unbalanced lifestyle, e.g. increased stress level, cigarette smoking
According to the study of The origins of gastric hyperacidity, gastric and duodenal ulcer appearance includes genetic predisposition, incorrect diet and unbalanced lifestyle, e.g. increased stress level, cigarette smoking(10).

3. Mechanical ventilation
Mechanical ventilation increases risk for bleeding in the upper part of the gastrointestinal tract. In the study to compare the effectiveness of famotidine (a histamine(2) antagonist) and pantoprazole (a proton pump inhibitor) in preventing stress ulcers in critically ill patients receiving mechanical ventilation, showed that in a total of 522 patients who received famotidine and 95 who received pantoprazole were included. Bleeding in the upper part of the gastrointestinal tract was more common in patients receiving pantoprazole than in patients receiving famotidine (0.38% vs 3.2%, P= .03)(11).
4. Excessive Alcohol  drinking
Too much alcohol can irritate and erode the mucous lining of your stomach, in some case prolonged period of excessive drinking can cause upper gastrointestinal bleeding, if damage of stomach limning is left untreated.
5. Etc.
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(1) http://www.ncbi.nlm.nih.gov/pubmed/8314506
(9) http://www.ncbi.nlm.nih.gov/pubmed/3477993
(10) http://www.ncbi.nlm.nih.gov/pubmed/16521987 
(11) http://www.ncbi.nlm.nih.gov/pubmed/18310651

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