An occupational health nurse provides monthly lunch and learn sessions to employees of a rail transportation manufacturer. This month, they are providing education on the risk factors for peptic ulcer disease. Which risk factors should the nurse include in the educational session?

Choice A reason: Helicobacter pylori infection is a major risk factor for peptic ulcer disease. It damages the gastric mucosa by producing urease, which neutralizes stomach acid, and toxins that cause inflammation and ulceration. Chronic infection leads to gastritis and weakens the mucosal barrier, increasing susceptibility to acid-induced damage and ulcer formation in the stomach or duodenum. Choice B reason: Spicy foods and a laid-back lifestyle are not established risk factors for peptic ulcer disease. Spicy foods may irritate existing ulcers but do not cause them. A laid-back lifestyle, implying low stress, does not contribute to ulceration, as stress is a minor factor compared to H. pylori or NSAIDs. These are myths not supported by scientific evidence. Choice C reason: An active lifestyle does not increase the risk of peptic ulcer disease and may even promote overall health. Smoking, however, is a risk factor, as it impairs mucosal blood flow and healing, but this option pairs it with an active lifestyle, which dilutes its relevance. Smoking alone would be a stronger risk factor, making this combination less accurate. Choice D reason: Alcohol abuse and smoking are significant risk factors for peptic ulcer disease. Alcohol irritates the gastric mucosa, increasing acid production and weakening the mucosal barrier. Smoking reduces mucosal blood flow, impairs healing, and enhances H. pylori-related damage. Together, they synergistically increase the risk of developing gastric or duodenal ulcers over time.