BMJ 1998;316:538-541 (14 February)

Education and debate

Stress and peptic ulcer: life beyond helicobacter

Susan Levenstein, adjunct research physician a

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.

Summary points

Psychosomatic factors in the aetiology of peptic ulcer have become unfashionable since the discovery of Helicobacter pylori

Most people harbour H pylori so the organism cannot serve as the sole explanation for ulcer disease

Psychological stress has an impact on the onset and course of ulcer disease

Psychological stress probably interacts with H pylori and other risk factors in causing ulcer disease

Peptic ulcer is an important example of the biopsychosocial model of disease


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