Are there immunologic forms of duodenal ulcer?

The increasing evidence for etiologic and genetic heterogeneity of peptic ulcer suggests that different pathogenetic mechanisms can result in peptic disease. The existence of immunologic forms of duodenal ulcer is proposed. These disorders may account for the varied results of reported HLA association studies. One form may be characterized by antibodies to secretory immunoglobulin, be overrepresented in childhood ulcer cases and allergic populations, and lead to ulcer through a deficiency of local mucosal immune defenses. Another form may be due to the production of an immunoglobulin that is stimulatory to acid secretion, analogous to the thyroid stimulating immunoglobulins of thyrotoxicosis. Studies to further delineate these proposed disorders are suggested.