Abstract
BackgroundThe association between stress and peptic ulcers has been questioned since the discovery of helicobacter pylori. This study examined whether high perceived everyday life stress was associated with an increased risk of either receiving a triple treatment or being diagnosed with a peptic ulcer.MethodsCohen’s perceived stress scale measured the level of stress in a general health survey in 2010 of 17,525 residents of northern Jutland, Denmark, and was linked with National Danish registers on prescription drugs and hospital diagnoses. Cox proportional hazard regression was used to estimate the risk of either receiving a triple treatment or being diagnosed in a hospital with a peptic ulcer, in relation to quintiles of stress levels.ResultsA total of 121 peptic ulcer incidents were recorded within 33 months of follow-up. The lowest stress group had a cumulative incidence proportion of either receiving triple treatment or being diagnosed with peptic ulcer of approximately 0.4%, whereas the highest stress group had a cumulative incidence proportion of approximately 1.2%. Compared with that of the lowest stress group, those in the highest stress group had a 2.2-fold increase in risk of either receiving triple treatment or being diagnosed with peptic ulcer (HR 2.24; CI 95% 1.16:4.35) after adjustment for age, gender, socioeconomic status, non-steroid anti-inflammatory drug use, former ulcer and health behaviours. There was no difference in risk between the four least stressed quintiles. Subgroup analysis of diagnosed peptic ulcer patients revealed the same pattern as the main analysis, although the results were not significant.ConclusionThe highest level of perceived everyday life stress raised the risk of either receiving triple treatment or being diagnosed with peptic ulcer during the following 33 months more than twice compared with that of the lowest level of perceived stress.
Highlights
The association between stress and peptic ulcers has been questioned since the discovery of helicobacter pylori
H. pylori infection [3, 4], non-steroid anti-inflammatory drug (NSAID) use [5, 6] and smoking are considered the main causes of peptic ulcers [2, 7, 8]
This study found that participants with the highest selfperceived stress level had a 2.2-fold higher risk of peptic ulcer treatment in 33 months of follow-up compared to participants with the lowest level of stress
Summary
The association between stress and peptic ulcers has been questioned since the discovery of helicobacter pylori. It was stressed that psychosocial factors, such as stress, depression and anxiety, were associated with impeded healing of duodenal ulcers [14, 15]. This suggests that these factors can influence the biological mechanisms (such as blood flow and gastric acid secretion) that can affect peptic ulcer development. This hypothesis was supported by several recent studies. In a sample of 233,093 Swedish males, decreased stress
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