Psychological Stress – Peptic Ulcers
A new study published in the journal Clinical Gastroenterology and Hepatology provides new evidence that stress is related to an increased risk of peptic ulcers.
Since the pioneering work of Hans Selye in the 1930s, psychological stress was often linked to the induction and progression of peptic ulcers.
In the 1950s-60s, Selye began to promote stress as the major cause of most human ills, and soon the idea that many diseases are an expression of the “failure of adaptation to non-specific stress” became widely popular. Some “examples of the diseases thought to result from stress are high blood pressure, peptic ulceration and coronary thrombosis” (cf. H. Simpson, Stress: Studies in Antarctica, 1959, New Scientist, 12 Nov. 927).
In 1982, however, the Helicobacter pylori bug was discovered (Marshall and Warren, Nobel Prize in Physiology & Medicine, 2005). This rapidly blurred the importance of psychological stress as a causative agent in peptic ulcers, and soon the Helicobacter became the single, monocausal explanation of this disease. Yet, in the 1990s several studies re-investigated the stress-ulcers link, including one large longitudinal population report, studies related to family and job difficulties and major societal disasters (cf. Susan Levenstein, BMJ 1998; 316:538–41).
Fascinatingly, in 1995, Barry Marshall, discussing whether or not Koch’s postulates have been fulfilled for H. pylori and peptic ulceration, concluded, quote: “only one of the many steps required for the development of peptic ulceration has so far been fulfilled, i.e. the ability of H. pylori to produce histological gastritis in a susceptible host” (BJ Marshall, Ann Med. 1995; 27:565).
In the Clinical Gastroenterology and Hepatology study, Susan Levenstein and colleagues, from the Aventino Medical Group, Rome, Italy, hypothesized that life stress would be a pre-dictor of documented incident ulcer, that the association between stress and ulcer would be attributable in part to health risk behaviors and in part to confounding by low socioeconomic status, and that psychological stress and H. pylori would be additive, independent ulcer risk factors.
As part of the world health organization’s MONICA study, examined a 10 year follow up of 3379 Danish adults without a history of ulcer diagnosis. Blood samples, psychological status and medical data were gathered from this population in 1982-83 and compared to 1993-94 samples.
At the end of the study, 76 participants were diagnosed as having peptic ulcer. The authors report that, based on a stress index scale, subjects in the highest tertile of stress scores, had significantly higher ulcer incidence. Also, their risk to develop ulcer was doubled, when compared to the lowest tertile patients’ group.
Of note, the risk to develop stress-related ulcer was similar in H. pylori seropositive or seronegative subjects. Exposition to NSAIDs did not influence the risk to develop stress-related ulcer either.
These results provide new evidence that psychological stress can increase the risk of peptic ulcer, independently of the presence of H. pylori or NSAIDs use. This also suggests that treatment of psychological stress may represent a therapeutic tool for peptic ulcers.
In conclusion, in this study, life stress at baseline increased the risk of subsequent confirmed peptic ulcer in a population-based cohort without a history of ulcer at baseline. The increased risk was not fully explained by confounding by socioeconomic status or by associations with nonsteroidal anti-inflammatory drugs and smoking, although the impact of stress on these health risk behaviors accounted for a portion of the increased risk.
Stress is increasing worldwide, and gastrointestinal disabilities are common problems observed during chronic stressful situations. The study of Levenstein et al., reformulates the actual knowledge about stress as a contributor, trigger and/or cause of peptic ulcer diseases.
Source: Clinical Gastroenterology and Hepatology, 2015. DOI: 10.1016/j.cgh.2014.07.052
Read More: Clinical Gastroenterology and Hepatology
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