- Bacterial infection by Helicobacter pylori breaks down the gastroduodenal mucosal barrier.
- The bacteria burrows through the barrier and releases bacterial digestive enzymes that liquefy the barrier.
- Stomach acid then penetrates into the epithelium of the gastric wall and breaks it down.
- Most peptic ulcers occur in the stomach and proximal duodenum. They arise as a result of an imbalance between acid secretion and mucosal defences. Heliobacter pylori infection is a significant aetiological factor and the eradication of this organism, as well as the attenuation of acid secretion, form the cornerstones of medical treatment. In a minority of cases the symptoms are not controlled by medical treatment alone and surgery is required. 'Very highly selective vagotomy' is a technique where only the afferent vagal fibres to the acid-secreting body are denervated thus not compromising the motor supply to the stomach and hence bypassing the need for a drainage procedure (e.g., gastrojejunostomy).
Reference:
1. Anatomy at a Glance. Omar Faiz and David Moffat. Blackwell Science. 2002.
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