Loading...
For decades, psychological stress has been thought to play a role in the development of peptic ulcers, but supporting data are scarce.
In a prospective, population-based study in Denmark, investigators collected blood samples and psychological (stress scale of 0–10), medical, and socioeconomic data from 3379 Danish residents without prior peptic ulcers at baseline (1982–1983). During 12 years of follow-up, based on participant interviews and hospital discharge data, 76 patients developed peptic ulcers.
Patients in the highest tertile of stress scores were more likely to develop ulcers than those in the lowest tertile (3.5% vs. 1.6%, adjusted odds ratio, 2.2; 95% confidence interval, 1.2–3.9). A one-point increase in the stress score increased the ulcer risk by 19% (OR, 1.19; 95% CI, 1.09–1.31). This was unaffected by Helicobacter pylori status. Adjusting for socioeconomic status decreased the OR to 1.17, and adjusting for smoking, use of nonsteroidal anti-inflammatory drugs (NSAIDs) and lack of exercise further decreased it to 1.11. In a multivariate model, the stress score, socioeconomic status, smoking, H. pylori infection, and NSAID use were independent predictors of ulcer risk.
Levenstein S et al. Psychological stress increases risk for peptic ulcer, regardless of Helicobacter pylori infection or use of nonsteroidal anti-inflammatory drugs. Clin Gastroenterol Hepatol 2014 Aug 8; [e-pub ahead of print]. (http://dx.doi.org/10.1016/j.cgh.2014.07.052)
Comment
This intriguing study has several limitations. First, asymptomatic ulcers and those diagnosed outside of a hospital were missed, resulting in a lower incidence than suggested in other studies. Nearly 1000 participants had been lost by the final interviews in 1993 and 1994. Also, the study took place during a time of rapidly evolving treatment for peptic ulcers, including H. pylori, histamine-2 receptor antagonists, and proton-pump inhibitors, which may have been given empirically to patients with symptoms. Despite these possible confounders, the finding of stress as an independent risk for peptic ulcers warrants further evaluation for validation and explanation.