Restoring Psychology's Role in Peptic Ulcer

Abstract

This paper reviews the history of the transition from the belief that gastrointestinal ulcers are caused primarily by psychological factors to the current state of belief that they are caused primarily by infection and argues that neither is fully accurate. We argue that psychological factors play a significant role as predisposing to vulnerability, modulating of precipitation, and sustaining of gastric ulceration. We review data that challenge the assumption of a simple infectious disease model and adduce recent preclinical data that confirm the predisposing, modulatory, and sustaining roles for psychological factors. We note that others, too, are now challenging the adequacy of the contemporary simple bacterial infection model. We hope to replace the competition between psychology and medicine with cooperation in understanding and treating patients suffering gastric ulceration and ulcer.

Associations between DSM-IV mental disorders and onset of self-reported peptic ulcer in the World Mental Health Surveys

“…Earlier research suggested that stress was a causal factor in gastrointestinal ulcer development [1, 2], but the subsequent discovery of the causal role of the Helicobacter pylori bacterium sharply diminished interest in stress-related ulcer research[1, 3, 4]. Although further research has established that H-pylori is neither a sufficient nor necessary cause of peptic ulcer [2, 3, 5], interest in stress and other psychological factors in ulcer development has not recovered [6].…”

Decreased stress resilience in young men significantly increases the risk of subsequent peptic ulcer disease – a prospective study of 233 093 men in Sweden

“…Poor stress resilience, and therefore stress, may increase the likelihood of behaviours and characteristics that in turn increase PUD risk. 4 Even though our study had no data on smoking, we did adjust for a measure of inflammation (ESR) in adolescence that has been linked with smoking although not always consistently. 25,[32][33][34][35] Cognitive function (and education) is strongly related to behaviours such as smoking, 36, 37 so we adjusted for this.…”

“…[2][3][4][5][6] Despite this, recent studies indicate that stress may still be relevant to the risk and course of PUD. 2,4,6,7 However, inconsistent results and potential methodological limitations warrant further research. Stressful life events have been associated with increased PUD risk in some studies, 2, 7-10 but others did not find this.…”

“…Smoking, 2, 4-6, 11 alcohol consumption 2, 4 and use of nonsteroidal anti-inflammatory drugs (NSAIDs) 4 are also linked with both psychosocial stress and higher PUD risk. Stress can increase the likelihood of exposure to the above risks and therefore PUD risk.…”

“…Stress can increase the likelihood of exposure to the above risks and therefore PUD risk. 4 Thus, stress resilience may influence PUD risk through behaviour resulting from the perception of higher stress levels. The aim of this study was to assess the association between stress resilience, objectively measured in adolescence, and subsequent PUD in a representative cohort of men from the general population in Sweden.…”