Gram-negative H. pylori colonize the surface of the gastric mucosa by growing in the layers of mucus covering the epithelial cells lining the stomach. It produces urease that decomposes urea to yield ammonia, which neutralizes the gastric acid's pH, allowing the organism to flourish. It also produces other enzymes that can break down the protective mucus layer, resulting in chronic gastritis. It also plays a role in gastric and duodenal ulcers by causing mucosal erosion and destruction.

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