Bacterial infection: Helicobacter pyroli is the chief cause of ulcer. It is spiral shaped, unipolar flagellum and is associated with astral gastritis and duodenitis in the presence of gastric metaphasia. If Helicobacter pylori is cleared by antibiotic treatment especially with colloidal bismuth and amoxicillin, the associated gastritis improves ulcer healing and recurrence rates may be lower.
Genetic factors: It is common in persons with blood group 'O' than in those of other groups and possibly in those with HLA-B5 antigens. People who are first degree relatives of patients with duodenal ulcer have an increased risk of developing duodenal ulcer.
Sex: Men are affected two to three times more frequently than women.
Age: The incidence is high between 20 and 40 years though the average age of incidence has increased. During these years career and personal strivings are at a peak.
Stress: People who are highly nervous and emotional and who worry, fear and feel anxiety are particularly susceptible. These emotional and nervous factors in turn may lead to hyper¬secretion and hypermotility of the stomach. The nervous control of the vascular system in the gastric or duodenal walls may be so disturbed that there is diminution in the blood supply to the mucosa of the stomach and duodenum making it susceptible to acid secretion.
Potentially irritant substances: Caffeine, ethanol, aspirin and nicotine may delay healing but there is little evidence to show that these substances induce ulcer. Chillies, pepper, ginger, garam masala, meat soups, strong tea or coffee and protein rich foods increase the secretion of hydrochloric acid and aggravate the condition.
High fibre diet: In India the incidence of peptic ulcer is low where the staple diet is millet or wheat compared to rice eating areas. This theory is yet to be confirmed.
Emergency injuries: Stress ulcers occur in conjunction with emergency injuries such as burns or long-term rehabilitation processes.