Other contributors to ulcer formation

NSAIDs: Chronic use of nonsteroidal anti-inflammatory drugs, or NSAIDs, such as aspirin or ibuprofen, inhibits the body's production of prostaglandins, the powerful hormonelike chemicals that protect the stomach lining and are integral to the body's inflammatory process. NSAIDs reduce inflammation from arthritis, tendonitis, and other conditions--but they also shut off the protective mechanism that keeps the mucosa healthy. NSAIDs are more likely to cause stomach ulcers rather than duodenal ulcers.

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Smoking: Cigarette smoking and H. pylori are cofactors in peptic ulcer disease, although their exact relationship is unclear. Cigarette smoking may increase susceptibility, diminish the gastric mucosal defensive factors, or provide a more favorable milieu for H. pylori infection. Smokers are about two times as likely to develop ulcer disease as nonsmokers.

Stress: Numerous studies have presented conflicting conclusions about the role of psychological stress in peptic ulcer disease. Stress may worsen ulcers, not cause them. However, in patients with duodenal ulcers, stress has been shown to increase acid secretion. Physical stress, meanwhile, may increase the risk of stomach ulcers. People with severe burns or those undergoing major surgery often require treatment to prevent ulcers.

Zollinger-Ellison syndrome (ZES): This rare disorder causes tumors in the pancreas and duodenum and ulcers in the stomach and duodenum. The tumors secrete a hormone called gastrin that causes the stomach to produce too much acid. The ulcers caused by ZES are less responsive to treatment than ordinary peptic ulcers. What causes people with ZES to develop tumors is unknown, but approximately 25 percent of ZES cases are associated with a genetic disorder called multiple endocrine neoplasia type 1.