Gastric Acid and Pepsin

Hydrochloric acid and pepsin are the primary substances that cause gastric mucosal damage in PUD. Three different stimuli (i.e., histamine, acetylcholine, and gastrin) are responsible for acid secretion through their interactions with the histaminic, choliner-gic, and gastrin receptors on the surface of parietal cells. Gastric acid output occurs in two stages: (a) basal acid output (BAO), which reflects the baseline output of acid during the fasting state; and (b) maximal acid output (MAO), which occurs in response to meals. Basal acid secretion follows a circadian cycle in which it is highest at night and lowest in the morning and is modulated by the effects of acetylcholine and histamine acting on the parietal cell.

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