On the pathophysiology of peptic ulcer formation

Peptic ulcer in man characterized by its rarity, singularity and chronicity coupled with a tendency to recidivate. Its rarity suggest the presence of protective mechanisms. The mucus barrier, cell regeneration and blood flow might be mentioned here. The singularity and chronic nature of this disease, together with the observation of varying lesion healing following polypectomy and gastric freezing, point to the probability of a vascular factor. The connecting link between an impaired protective mechanism and a vascular factor is the back diffusion of acid. A "weakened" mucus barrier opens up the way for an attack by the hydrogen ions on vessels in the regions of the stomach which manifest only a poorly developed vascular plexus. To such regions belongs, in particular, the lesser curvature. For the therapy, the following consequences derive from these pathophysiological condiserations: 1. Attenuation of the aggressive gastric juice by anticholinergics and antihistamines of the H2 receptor blocker type and secretin. 2 Distraction of the aggressor by a diet capable of producing a buffering effect, antacids, antipepsins and alkaline pancreatic secretion stimulated by secretin. 3. Strengthening of the mucus barrier by the administration of carbenoxolone. 4. Reduction of the vascular susceptibility to the formation of thromboses.