However, when the integrity of these protective factors is impaired, an ulcer can form. The role of the bacteria H. pylori in peptic ulcer disease has been extensively investigated. 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.