A 48 year old man is seen by his primary care physician because of persistent epigastricpain and nausea for the past month. He has had no vomiting or signs of gastrointestinal
bleeding. He denies heartburn. He takes 8 ibuprofen daily for arthritic complaints. A urea
breath test is negative. An upper endoscopy reveals multiple small ulcers in the gastric
antrum. Biopsies are negative for malignancy. The patient is placed on omeprazole and
his symptoms resolve. A repeat upper endoscopy 6 weeks later shows healing of the
ulcers.
Which of the following best explains the pathophysiologic mechanism behind the
development of ulcers in this patient?
