However, less than a third of peptic ulcers develop in people with H pylori infection or users of NSAIDs.
Susan Levenstein et al. performed a prospective study to investigate the true association between stress, as well as other factors, and ulcers. They collected data on life stress in a defined population in Denmark and then followed the subjects to see which ones developed peptic ulcers over the next 12 years.
Levenstein described her findings in a video abstract:
“Among subjects in the lowest tertile of stress at baseline, 1.6% developed an ulcer. Among those in the highest tertile, 3.5% developed an ulcer, meaning that stress more than doubled the risk”, Levenstein says in the video.
“Somewhat to our surprise, stress was just as associated with ulcer among patients who had H pylori infection as it was among patients with neither H pylori infection nor exposure to NSAIDs,” Levenstein added.
In multivariate analysis, stress, smoking, H pylori, socioeconomic status, and use of NSAIDs were all independent predictors of ulcer, she says.
H pylori and NSAIDs should not be considered “THE causes of peptic ulcer, but as risk factors alongside stress and smoking”, Levenstein concludes.
“Clinicians treating ulcer should be alert to their patients’ life circumstances and psychological states,” she says.