Predisposing factors for H. pylori infection are low gastric output as well as low antioxidant content in the gastrointestinal lining. In other words, H. pylori infection leads to ulcer formation and ulcer formation leads to H. pylori infection. Probably more important causes of ulcers than H. pylori are aspirin and smoking. Smoking is a significant factor in the occurrence and severity of peptic ulcers. Increased frequency, decreased response to peptic ulcer therapy, and an increased mortality due to peptic ulcers are all related to smoking.
Smoking causes ulcers by at least three mechanisms.
Bile salts are extremely irritating to the stomach and initial portions of the duodenum, bile salt reflux induced by smoking appears to be the most significant factor responsible for the increased peptic ulcer rate in smokers. In addition, the psychological aspects of smoking are also important, since the chronic anxiety and psychological stress associated with smoking appear to worsen ulcer activity. Stress is universally believed to be an important causative factor in peptic ulcers. However, this link is quite controversial in the medical literature. One of the big problems is that studies attempting to examine this assumption about stress and ulcers have been poorly designed.6 The data suggests that it is not simply the amount of stress, but rather the patient's response to it that is the significant factor.