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Esophageal ulcer - Causes
Last reviewed: 06.07.2025
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A distinction is made between true (peptic) and symptomatic ulcers of the esophagus.
True esophageal ulcers are peptic ulcers that occur in individuals with esophageal hiatus hernia, cardiac insufficiency, and gastroesophageal reflux disease.
The following factors play a role in the mechanism of development of true (peptic) ulcers:
- the impact of aggressive factors of gastric juice - hydrochloric acid and pepsin;
- dysfunction of the central nervous system and imbalance in the production of gastrointestinal hormones;
- heterotopia of the gastric mucosa and, consequently, of the columnar epithelium in the esophagus.
Symptomatic ulcers are those in which there is no hernia of the esophageal opening of the diaphragm, cardiac insufficiency, or gastroesophageal reflux (V. M. Nechaev, 1997).
Etiological variants of symptomatic ulcers:
- Congestive esophageal ulcers - occur with benign and malignant tumors of the esophagus, its stenosis and diverticula.
- Viral esophageal ulcers - observed in drug addicts, homosexuals and people with acquired immunodeficiency syndrome. Influenza virus, cytomegalovirus, and HIV are isolated from the edges of these ulcers in biopsies.
- Stress esophageal ulcers - occur with extensive skin burns and diseases of the central nervous system.
- Drug-induced esophageal ulcers - occur as a result of treatment with nonsteroidal anti-inflammatory drugs, cytostatics, potassium chloride, and some antibiotics (doxycycline, clindamycin). These ulcers are caused by the toxic effect of these drugs on the esophageal mucosa.
- Decubital esophageal ulcers - occur in seriously ill patients who have a permanent gastric tube installed.
- Esophageal ulcers in Sjogren's and Bschet's syndromes.