A wide range of mucosal lesions may be included, ranging from small petechial haemorrhages and erosions to deep ulceration and occasional perforation. Matched groups of patients were compared and it was found that those who developed peptic ulcers were more limited by chronic disease and ability to ambulate. It was concluded that helplessness in responding to environmental demands produced stress sufficient to induce peptic ulcers. There is strong evidence that cigarette smoking, regular use of aspirin and prolonged use of steroids are associated with the development of peptic ulcer. There is some evidence that coffee and aspirin substitutes may affect ulcers, but most studies do not implicate alcohol, food or psychological stress as causes of ulcer disease.
Genetic factors play a role in both gastric and duodenal ulcer.
Associated Diseases and Conditions. It was recognised early that the chance of overt bleeding occurring increased with the increase in number of risk factors. In the Intensive Care setting, these risk factors included renal failure, peritonitis, hypotension, jaundice, major operative procedures and respiratory failure. Fulminant Hepatic Failure Often complicated by acute upper gastrointestinal haemorrhage and bleeding. Sepsis Severe sepsis is commonly associated with stress ulceration.