Peptic ulceration is related to protective barrier loss leading to acid or biliary damage of the underlying mucosa and submucosa. Barrier loss occurs secondary to critical illness, alcohol, drugs, e.g. non-steroidals, poisons including corrosives. Direct damage, especially at the lower oesophagus, may occur from feeding tubes. Mucosal damage ('stress ulcers') may also occur as a consequence of tissue hypoperfusion. Gastric hypersecretion is uncommon in critically ill patients; indeed, gastric acid content and secretion is often reduced.

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