Education and debate

Stress and peptic ulcer: life beyond helicobacter

^a Gastroenterology Service, Nuovo Regina Margherita Hospital, Viale Trastevere 72, Rome, Italy

Correspondence to: Dr Levenstein Via del Tempio 1A, 00186 Rome, Italy 100424.3254@compuserve.com

The discovery that Helicobacter pylori is a cause of peptic ulcer has tempted many to conclude that psychological factors are unimportant. But this is dichotomised thinking. There is solid evidence that psychological stress triggers many ulcers and impairs response to treatment, while helicobacter is inadequate as a monocausal explanation as most infected people do not develop ulcers. Psychological stress probably functions most often as a cofactor with H pylori. It may act by stimulating the production of gastric acid or by promoting behaviour that causes a risk to health. Unravelling the aetiology of peptic ulcer will make an important contribution to the biopsychosocial model of disease.
For this review of the role of psychological stress in the aetiology of peptic ulcer disease, I undertook conventional journal tracking and reference tracing, supplemented by Medline searches using Paperchase. The important keywords used in this search included peptic ulcer; duodenal ulcer—psychology; stress; life change events; and personality.

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