Question

Dave is under a lot of stress at his job and at home. Lately, he has begun to feel discomfort and a burning sensation in his abdomen following each meal. After consulting a doctor, he finds that he has developed a duodenal ulcer. He does not understand how being nervous would cause an ulcer. Explain the cause and effect in his case.

Answer 1

Ulcers are caused by ischemic injury to the gastric mucosa, loss of cytoprotectants and assault by gastric acid.

The mucosa is injured and cannot repair itself sufficiently well to ward off aggressive factors present in the gut lumen ( these aggressors include gastric acid, bile and digestive enzymes)

The stress results in increase in level of HCL. There will be mucosa ischemia resulting from splanchnic hypofusion in the setting of physiologic stress and an acid.

There will be disproportionate vasoconstrictor response to stress. This is through

• neural nor- adrenaline and circulating adrenaline have similar effects on vasoconstriction in gastric mucosal and systemic vascular beds.
• Renin - angiotensin system and to a lesser degree vasopressin are responsible for the disproportionate response.
• The mucosa is compromised by ischemia and attacked by acid.
• It is injured and due to the presence of acid, cannot repair itself.
• The use of external agents to neutralize and resolves this problem.

IN Normal gut, acid is repelled.

In critical illness, because of the loss of protective barrier and loss of ability to repair, acid causes ulceration and bleeding.