Peptic Ulcers: Stress Does Matter, After All

June 17, 1998

With the discovery in the late 1980s that bacteria were involved in causing peptic ulcers, many doctors dropped the notion that stress causes ulcers and declared them merely an infectious disease.

Not so, says an expert panel convened this month by the Academy of Behavioral Medicine Research. The experts looked over the evidence and concluded that ulcers are not merely an infectious disease and that psychological factors do play a significant role.

According to the panel's chair, Dr. Susan Levenstein, of the Nuovo Regina Margherita Hospital in Rome, more than four out of five people who are infected with Helicobacter never develop ulcers, while some people who develop ulcers have never been exposed to Helicobacter pylori (H.pylori), the bacterium blamed for "causing" ulcers.

"This shows that other factors must be involved," points out Levenstein, who has researched the causes of ulcers for over 10 years. "Stress is probably one of them. Studies show that people who live through wars, earthquakes, or even large doses of the ordinary stresses of life are especially likely to develop ulcers, and ulcer patients who are anxious or under stress have a harder time healing and staying healed."

Other research has suggested that psychological stress may push a H.pylori-infected person over the edge into developing an ulcer, and may even help H.pylori multiply in the body. Researchers are trying to trace in both animals and humans how stress might promote H.pylori infection (present in most adults) into ulcers (which develop in few).

For instance, the stomach secretes more acid under stress, which can probably help the bacteria multiply. Also, people under stress often smoke more, drink heavily, and skip meals, behaviors that make it more likely they will get ulcers.

"I have a suspicion that one reason the medical establishment wiped stress off the charts so fast," Levenstein says, "was that it didn't feel comfortable with psychological explanations. They were happier when they could label ulcers as an infectious disease. It's easy to fall into either-or thinking: either ulcers are caused by stress or they're caused by Helicobacter.

"The truth is much more complicated - and, I think, more exciting. Since peptic ulcer is one of the few `infectious' diseases in which stress plays an important role, it gives us a great model for understanding how psychological factors can tip the balance toward disease, in the uneasy equilibrium we all live in with a whole variety of infectious agents."

Although less frequent in recent years, peptic ulcer is still an important cause of suffering and time lost from work, and despite the great advances medical science has made against the disease - including treatment for H.pylori - many people still live with its symptoms. "Stress has an influence on the development of ulcers," adds Levenstein, "but it also strongly influences how well you do under treatment once you have an ulcer."

Panelists included Howard Spiro, M.D., of Yale, one of the most eminent gastroenterologists in the nation; Andre Dubois, M.D., of the Uniformed Services University of the Health Sciences, Bethesda, Maryland, who studies gastric secretion and the role of H.pylori in gastro-duodenal disease; Janice Kiecolt-Glaser, PhD, of Ohio State University College of Medicine, a trailblazing researcher in psychoneuroimmunology (how the mind can influence the immune system); and Sigurd Ackerman, M.D., chair of psychiatry at St. Luke's in New York City.


Center for Advancing Health

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