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A gastric ulcer is a break in the gastric mucosa that extends through the muscularis mucosa into the submucosa or deeper layers, commonly due to imbalance between mucosal defensive mechanisms and aggressive factors like acid and pepsin.

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Etiopathogenesis

Aggressive factors

• Helicobacter pylori infection (major cause).
• NSAIDs / aspirin → inhibit prostaglandin synthesis.
• Gastric acid and pepsin hypersecretion.
• Alcohol, smoking, corticosteroids.
• Bile reflux.

Defensive factors impaired

• Mucus-bicarbonate barrier disruption.
• Reduced mucosal blood flow.
• Impaired epithelial regeneration.

Other associations

• Stress-related mucosal damage (ICU patients).
• Zollinger-Ellison syndrome gastrinoma with high acid).
• Malignancy: 5–10% of gastric ulcers may harbor carcinoma (hence biopsy is essential).

Pathology

• Gross: Round/oval, punched-out mucosal defect with surrounding edema; usually on the lesser curvature of the stomach, especially near the incisura angularis.