Long-term symptom patterns in duodenal ulcer: Psychosocial factors

Levenstein, Susan; Prantera, Cosimo; Varvo, Vilma; Arcà, Massimo; Scribano, Maria Lia; Spinella, Sabrina; Berto, Eva

doi:10.1016/s0022-3999(96)00196-1

Cited by 18 publications

(11 citation statements)

References 31 publications

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“…This suggests that psychological risk factors have an independent role not confounded by associated high-risk behaviors. Levenstein et al [68] also reported that patients with endoscopically proven duodenal ulcer were more likely to have persistent symptoms despite treatment if they had a low-status occupation, depression, stressful life events, or an abnormal MMPI at baseline. Patients with persistent symptoms did not undergo repeat endoscopy to prove or disprove ulcer persistence or recurrence.…”

Section: Psychophysiological Mechanisms For Stress and Ulcer Diseasementioning

confidence: 99%

The role of psychosocial factors in peptic ulcer disease: Beyond Helicobacter pylori and NSAIDs

Jones

2006

Journal of Psychosomatic Research

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Section: Psychophysiological Mechanisms For Stress and Ulcer Diseasementioning

confidence: 99%

The role of psychosocial factors in peptic ulcer disease: Beyond Helicobacter pylori and NSAIDs

Jones

2006

Journal of Psychosomatic Research

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“…Life stress continued to worsen the prognosis over several years in two prospective case series 23 24. This effect seems to be reversible, however: a psychologically stable person who develops an ulcer during a stressful period is likely to remain free of symptoms for years after a short course of treatment, even without medication to eradicate H pylori 24…”

Section: Stress and Ulcers: The Evidencementioning

confidence: 99%

Stress and peptic ulcer: life beyond helicobacter

Levenstein¹

1998

BMJ

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The discovery that Helicobacter pylori is a cause of peptic ulcer has tempted many to conclude that psychological factors are unimportant. But this is dichotomised thinking. There is solid evidence that psychological stress triggers many ulcers and impairs response to treatment, while helicobacter is inadequate as a monocausal explanation as most infected people do not develop ulcers. Psychological stress probably functions most often as a cofactor with H pylori. It may act by stimulating the production of gastric acid or by promoting behaviour that causes a risk to health. Unravelling the aetiology of peptic ulcer will make an important contribution to the biopsychosocial model of disease. For this review of the role of psychological stress in the aetiology of peptic ulcer disease, I undertook conventional journal tracking and reference tracing, supplemented by Medline searches using Paperchase. The important keywords used in this search included peptic ulcer; duodenal ulcer—psychology; stress; life change events; and personality. Summary points Psychosomatic factors in the aetiology of peptic ulcer have become unfashionable since the discovery of Helicobacter pylori Most people harbour H pylori so the organism cannot serve as the sole explanation for ulcer disease Psychological stress has an impact on the onset and course of ulcer disease Psychological stress probably interacts with H pylori and other risk factors in causing ulcer disease Peptic ulcer is an important example of the biopsychosocial model of disease

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“…A number of factors have been identified as possible determinants in the development of peptic ulcers (smoking [2, 17–24], NSAID use [2, 5, 7, 17, 20], gender [9, 17, 25, 26], age [17, 21, 26], socioeconomic status [9, 25, 27–29], alcohol consumption [18, 22, 24], gastric acid secretion [3, 16], lack of sleep [18], home crowding [16], strenuous work [9, 29], family history [30] and body weight [15, 21]). Furthermore, a number of studies indicated stress or stress-related incidents as a risk factor for the development of a peptic ulcer [5, 13, 16, 17, 21, 30].…”

Section: Introductionmentioning

confidence: 99%

Perceived stress as a risk factor for peptic ulcers: a register-based cohort study

et al. 2016

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BackgroundThe association between stress and peptic ulcers has been questioned since the discovery of helicobacter pylori. This study examined whether high perceived everyday life stress was associated with an increased risk of either receiving a triple treatment or being diagnosed with a peptic ulcer.MethodsCohen’s perceived stress scale measured the level of stress in a general health survey in 2010 of 17,525 residents of northern Jutland, Denmark, and was linked with National Danish registers on prescription drugs and hospital diagnoses. Cox proportional hazard regression was used to estimate the risk of either receiving a triple treatment or being diagnosed in a hospital with a peptic ulcer, in relation to quintiles of stress levels.ResultsA total of 121 peptic ulcer incidents were recorded within 33 months of follow-up. The lowest stress group had a cumulative incidence proportion of either receiving triple treatment or being diagnosed with peptic ulcer of approximately 0.4%, whereas the highest stress group had a cumulative incidence proportion of approximately 1.2%. Compared with that of the lowest stress group, those in the highest stress group had a 2.2-fold increase in risk of either receiving triple treatment or being diagnosed with peptic ulcer (HR 2.24; CI 95% 1.16:4.35) after adjustment for age, gender, socioeconomic status, non-steroid anti-inflammatory drug use, former ulcer and health behaviours. There was no difference in risk between the four least stressed quintiles. Subgroup analysis of diagnosed peptic ulcer patients revealed the same pattern as the main analysis, although the results were not significant.ConclusionThe highest level of perceived everyday life stress raised the risk of either receiving triple treatment or being diagnosed with peptic ulcer during the following 33 months more than twice compared with that of the lowest level of perceived stress.

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Long-term symptom patterns in duodenal ulcer: Psychosocial factors

Cited by 18 publications

References 31 publications

The role of psychosocial factors in peptic ulcer disease: Beyond Helicobacter pylori and NSAIDs

The role of psychosocial factors in peptic ulcer disease: Beyond Helicobacter pylori and NSAIDs

Stress and peptic ulcer: life beyond helicobacter

Perceived stress as a risk factor for peptic ulcers: a register-based cohort study

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