Stress Still Plays A Role in Ulcer Formation

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Focus on bacteria may overshadow mind-body connection

NOT FIVE YEARS ago, most doctors and patients alike believed that stress--a job loss, a death in the family, a divorce--played a key role in causing ulcers. But campaigns to educate people that most ulcers are actually brought on by H. pylori bacteria have been so successful that the stress connection has been rather abruptly dismissed.

Too abruptly, some physicians argued recently in the Journal of the American Medical Association. They contend that in the haste to label ulcers as an easily treatable bacterial infection, many doctors have forgotten that stress can still play a role. As evidence, they note that the prevalence of ulcers increased after events such as the German blitz in London during World War II and the 1995 Kobe earthquake in Japan. There's evidence, too, that people who experience less violent but emotionally unsettling events, such as financial or marital strain, may also be more likely to develop ulcers.

Tufts gastroenterologist Robert Russell, MD, comments that emotional stress can raise ulcer risk by increasing a person's output of stomach acid. It's acid that eventually creates ulcers by eating away at the stomach or intestinal lining. Add emotional stress to an H. pylori infection (which also causes an increase in stomach acid) and the conditions become even more conducive to ulcer development.

Furthermore, Dr. Russell says, it may be that stress suppresses the body's defenses, thereby making a person more vulnerable to ulcer formation. For example, stress could perhaps decrease the intestinal lining's resistance to an onslaught of excess acid.

"What it boils down to," says Dr. Russell, is that "stress continues to play a role" in ulcer formation, despite the fact that the pendulum of scientific opinion has swung toward H. pylori as the cause. By itself, stress might account for a very few cases of ulcers, says Dr. Russell. But that doesn't mean that its potential boost to ulcer formation should be ignored. "If you've been under persistent stress and you're experiencing stomach symptoms, it's possible you could be developing an ulcer," he warns--and it's time to seek a doctor's advice. Be on the lookout for gnawing or burning pain (but not acute, sharp pain) around the stomach; pain in between meals; or an unremitting feeling of slight nausea or hunger that's relieved by eating.

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