Ulcers
Question Received:
Response:
Can you tell me if daily stress (emotional) can cause or contribute to the development of ulcers?
22nd March 2000
There is not a simple yes/no answer to this question. Mild, everyday stressors (eustressors) are probably beneficial to health, causing motivation, movement, and achievement. Extreme, longlasting, or unusual stressors (distressors) have the potential to produce ill-health and possibly death if not suitably managed. Undoubtedly, prolonged emotional stress can have a detrimental effect on an individual's health as homeostatic mechanisms are put under pressure and may eventually become exhausted (McEwen and Stellar, 1993). Emotional stress may also lead to a person adopting forms of behaviour that have a negative impact on health, for example eating more, making inappropriate dietary choices, drinking to excess, or smoking. These changes may render a person more susceptible to a breakdown in their health.
At one time it was thought that stress, missing meals and generally eating at irregular intervals favoured the formation of peptic ulcers, the idea being that an increased secretion of hydrochloric acid and pepsin triggered by the stress would - with little or no food in the stomach - erode the protective lining. However, hypersecretion of acid is not commonly a feature of peptic ulceration, and some patients may develop ulcers in the absence of hydrochloric acid secretion (McLatchie, 1992). Palmer and Penman (1999) suggest that a peptic ulcer forms when there is an imbalance between ‘aggressive’ factors such as the hydrochloric acid and pepsin in the gastric juices and the ability of ‘defensive’ factors such as the gastric and duodenal mucosa to resist these.
In the last two decades there there has been a move away from the interpretation that stress and dietary indiscretion are key causative factors for peptic ulcers towards the observation that most are caused by Helicobacter pylori infections and the use of non-steroidal anti inflammatory drugs (NSAIDs) such as aspirin (Porth, 1998). The familial aggregation of peptic ulcer originally attributed to genetic susceptibility may thus be due to intra-familial infection with Helicobacter pylori.
(The situation is less clear with regard to other types of ulceration such as varicose, necrotic and malignant ulcers.)
Therefore, although unremitting stress can be damaging to one’s health, most peptic ulcers develop as a consequence of an infectious process and can be treated effectively with a course of antibiotics, and others are an indirect consequence of treatment with NSAIDs.
References
Long, R.G., and Beck, E.R. (1990) Gastrointestinal diseases. In: Textbook of medicine, edited by R.L. Souhami and J. Moxham. Edinburgh: Churchill Livingstone (p 576: aetiology of peptic ulcers).
McEwen, B.S., and Stellar, E. (1993) Stress and the individual. Mechanisms leading to disease. Archives of Internal Medicine, 153 (18), 2093-2101 (Sep 27).
McLatchie, G.R. (1992) General surgery & gastro intestinal disease. In: Oxford handbook of clinical surgery. Oxford: Oxford University Press (p 152: peptic ulceration).
Palmer, K.R., and Penman, I.D. (1999) Diseases of the alimentary tract and pancreas. In: Davidson's Principles & Practice of Medicine. Edinburgh: Churchill Livingstone (p 633).
Porth, C.T. (1998) Alterations in gastrointestinal function. In: Pathophysiology - concepts of altered health states, edited by L. Stead and C. Vaughn. Lippincott - Raven (p 725).