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BMC Gastroenterology
Published in: BMC Gastroenterology 1/2016

Open Access 01-12-2016 | Research article

Perceived stress as a risk factor for peptic ulcers: a register-based cohort study

Authors: Ulrik Deding, Linda Ejlskov, Mads Phillip Kofoed Grabas, Berit Jamie Nielsen, Christian Torp-Pedersen, Henrik Bøggild

Published in: BMC Gastroenterology | Issue 1/2016

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Abstract

Background

The 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.

Methods

Cohen’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.

Results

A 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.

Conclusion

The 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.
Appendix
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Literature
1.
Levenstein S. The very model of a modern etiology: a biopsychosocial view of peptic ulcer. Psychosom Med. 2000;62:176–85.CrossRefPubMed
2.
Kurata JH, Nogawa AN. Meta-analysis of risk factors for peptic ulcer. Nonsteroidal antiinflammatory drugs, Helicobacter pylori, and smoking. J Clin Gastroenterol. 1997;24:2–17.CrossRefPubMed
3.
Rauws EAJ, Tytgat GNJ. Cure of duodenal ulcer associated with eradication of Helicobacter pylori. Lancet. 1990;335:1233–5.CrossRefPubMed
4.
Ciociola A, McSorley DJ, Turner K, Sykes D, Palmer JB. Helicobacter pylori infection rates in duodenal ulcer patients in the United States may be lower than previously estimated. Am J Gastroenterol. 1999;94:1834–40.CrossRefPubMed
5.
Chen TS, Chang FY. Clinical characteristics of Helicobacter pylori-negative duodenal ulcer disease. Hepatogastroenterologyl. 2008;55:1615–8.
6.
7.
Chen T-S, Luo J-C, Chang F-Y. Prevalence of Helicobacter pylori infection in duodenal ulcer and gastro-duodenal ulcer diseases in Taiwan. J Gastroenterol Hepatol. 2010;25:919–22.CrossRefPubMed
8.
9.
Levenstein S, Kaplan GA. Socioeconomic status and ulcer. A prospective study of contributory risk factors. J Clin Gastroenterol. 1998;26:7–14.CrossRef
10.
Levenstein S, Rosenstock S, Jacobsen RK, Jorgensen T. Psychological stress increases risk for peptic ulcer, regardless of helicobacter pylori infection or use of nonsteroidal anti-inflammatory drugs. Clin Gastroenterol H. 2015;13:498–506.CrossRef
11.
Konturek SJ, Bielański W, Płonka M, Pawlik T, Pepera J, Konturek PC, et al. Helicobacter pylori, non-steroidal anti-inflammatory drugs and smoking in risk pattern of gastroduodenal ulcers. Scand J Gastroenterol. 2003;38:923–30.CrossRefPubMed
12.
13.
Ruigomez A, Johansson S, Nagy P, Martin-Perez M, Rodriguez LA. Risk of uncomplicated peptic ulcer disease in a cohort of new users of low-dose acetylsalicylic acid for secondary prevention of cardiovascular events. BMC Gastroenterol. 2014;14:205–15.CrossRefPubMedPubMedCentral
14.
Levenstein S, Prantera C, Scribano ML, Varvo V, Berto E, Spinella S. Psychologic predictors of duodenal ulcer healing. J Clin Gastroenterol. 1996;22:84–9.CrossRefPubMed
15.
Holtmann G, Armstrong D, Pöppel E, Bauerfeind A, Goebell H, Arnold R, et al. Influence of Stress on the Healing and Relapse of Duodenal Ulcers. A Prospective, Multicenter Trial of 2109 Patients with Recurrent Duodenal Ulceration Treated with Ranitidine. Scand J Gastroenterol. 1992;27:917–23.CrossRefPubMed
16.
Melinder C, Udumyan R, Hiyoshi A, Brummer RJ, Montgomery S. Decreased stress resilience in young men significantly increases the risk of subsequent peptic ulcer disease - A prospective study of 233 093 men in Sweden. Aliment Pharmacol Ther. 2015;41:1005–15.CrossRefPubMed
17.
Anda RF, Williamson DF, Escobedo LG, Remington PL, Mast EE, Madans JH. Self-perceived stress and the risk of peptic ulcer disease. Arch Intern Med. 1992;152:829–33.CrossRefPubMed
18.
Levenstein S, Kaplan GA, Smith MW. Psychological predictors of peptic ulcer incidence in the Alameda County Study. J Clin Gastroenterol. 1997;24:140–6.CrossRefPubMed
19.
Rutter M. Psychosocial factors in the short-term prognosis of physical disease: I. Peptic ulcer. J Psychosom Res. 1963;7:45–60.CrossRefPubMed
20.
Shigemi J, Mino Y, Tsuda T. The role of perceived job stress in the relationship between smoking and the development of peptic ulcers. J Epidemiol. 1999;9:320–6.CrossRefPubMed
21.
Medalie JH, Stange KC, Zyzanski S, Goldbourt U. The importance of biopsychosocial factors in the development of duodenal ulcer in a cohort of middle-aged Men. Am J Epidemiol. 1992;136:1280–7.CrossRefPubMed
22.
Rosenstock S, Jørgensen T, Bonnevie O, Andersen L. Risk factors for peptic ulcer disease: a population based prospective cohort study comprising 2416 Danish adults. Gut. 2003;52:186–93.CrossRefPubMedPubMedCentral
23.
Raiha I, Kemppainen H, Kaprio J, Koskenvuo M, Sourander L. Lifestyle, stress, and genes in peptic ulcer disease: a nationwide twin cohort study. Arch Intern Med. 1998;158:698–704.CrossRefPubMed
24.
Andersen IB, Jørgensen T, Bonnevie O, Grønbæk M, Sørensen TIA. Smoking and alcohol intake as risk factors for bleeding and perforated peptic ulcers: a population-based cohort study. Epidemiology. 2000;11:434–9.CrossRefPubMed
25.
Levenstein S, Kaplan GA, Smith M. Sociodemographic characteristics, life stressors, and peptic ulcer. A prospective study. J Clin Gastroenterol. 1995;21:185–92.CrossRefPubMed
26.
Furuse M, Kumano H, Yoshiuchi K, Yamauchi Y. Psychosocial factors associated with peptic ulcer in aged persons. Psychol Rep. 1999;85:761–9.CrossRefPubMed
27.
Levenstein S, Prantera C, Varvo V, Arca M, Scribano ML, Spinella S, et al. Long-term symptom patterns in duodenal ulcer: psychosocial factors. J Psychosom Res. 1996;41:465–72.CrossRefPubMed
28.
Haug TT, Svebak S, Wilhelmsen I, Berstad A, Ursin H. Psychological factors and somatic symptoms in functional dyspepsia. A comparison with duodenal ulcer and healthy controls. J Psychosom Res. 1994;38:281–91.CrossRefPubMed
29.
Rosenstock SJ, Jørgensen T, Bonnevie O, Andersen LP. Does Helicobacter pylori infection explain all socio-economic differences in peptic ulcer incidence? Genetic and psychosocial markers for incident peptic ulcer disease in a large cohort of Danish adults. Scand J Gastroenterol. 2004;39:823–9.CrossRefPubMed
30.
Wachirawat W, Suriyawongpaisal P, Levenstein S, Atisook K, Theerabutr C, Hanucharurnkul S, et al. Stress, but not Helicobacter pylori, is associated with peptic ulcer disease in a Thai population. J Med Assoc Thai. 2003;86:672–85.PubMed
31.
Johnsen R, Forde OH, Straume B, Burhol PG. Aetiology of peptic ulcer: A prospective population study in Norway. J Epidemiol Community Health. 1994;48:156–60.CrossRefPubMedPubMedCentral
32.
Song EM, Jung HK, Jung JM. The association between reflux esophagitis and psychosocial stress. Dig Dis Sci. 2013;58:471–7.CrossRefPubMed
33.
34.
Cohen S, Williamson G. Perceived stress in a probability sample of the United States. In: Spacapan S, Oskamp S, editors. Soc. Psychol. Heal. Newbury Park, CA; 1988. p. 31–67.
35.
36.
Kildemoes HW, Sørensen HT, Hallas J. The Danish National Prescription Registry. Scand J Public Health. 2011;39:38–41.CrossRefPubMed
37.
Lynge E, Sandegaard JL, Rebolj M. The Danish National Patient Register. Scand J Public Health. 2011;39:30–3.CrossRefPubMed
38.
Baadsgaard M, Quitzau J. Danish registers on personal income and transfer payments. Scand J Public Health. 2011;39:103–5.CrossRefPubMed
39.
40.
Taylor JM. Psychometric analysis of the ten-item perceived stress scale. Psychol Assess. 2015;27:90–101.CrossRefPubMed
41.
Cohen S, Janicki-Deverts D. Who’s stressed? distributions of psychological stress in the united states in probability samples from 1983, 2006, and 2009. J Appl Soc Psychol. 2012;42:1320–34.CrossRef
42.
43.
Ables AZ, Simon I, Melton ER. Update on Helicobacter pylori treatment. Am Fam Physician. 2007;75:351–8.PubMed
44.
45.
46.
47.
The EUROGAST Studygroup. Epidemiology of, and risk factors for, Helicobacter pylori infection among 3194 asymptomatic subjects in 17 populations. Gut. 1993;34:1672-76.
48.
Graham DY, Malaty HM, Evans DG, Evans Jr DJ, Klein PD, Adam E. Epidemiology of Helicobacter pylori in an Asymptomatic Population in the United States. Gastroenterology. 1991;100:1495–501.CrossRefPubMed
49.
Kanno T, Iijima K, Abe Y, Koike T, Shimada N, Hoshi T, et al. Peptic ulcers after the great east japan earthquake and tsunami: possible existence of psychosocial stress ulcers in humans. J Gastroenterol. 2013;48:483–90.CrossRefPubMed
50.
Stack WA, Atherton JC, Hawkey GM, Logan RFA, Hawkey CJ. Interactions between Helicobacter pylori and other risk factors for peptic ulcer bleeding. Aliment Pharmacol Ther. 2002;16:497–506.CrossRefPubMed
51.
Borody TJ, George LL, Brandl S, Andrews P, Jankiewicz E, Ostapowicz N. Smoking does Not contribute to duodenal ulcer relapse after helicobacter pylori eradication. Am J Gastroenterol. 1992;87:1390–3.PubMed
52.
Rosenstock S, Kay L, Rosenstock C, Andersen LP, Bonnevie O, Jørgensen T. Relation between Helicobacter pylori infection and gastrointestinal symptoms and syndromes. Gut. 1997;41:169–76.CrossRefPubMedPubMedCentral
53.
Thygesen LC, Daasnes C, Thaulow I, Bronnum-Hansen H. Introduction to danish (nationwide) registers on health and social issues: structure, access, legislation, and archiving. Scand J Public Health. 2011;39:12–6.CrossRefPubMed
54.
Metadata
Title
Perceived stress as a risk factor for peptic ulcers: a register-based cohort study
Authors
Ulrik Deding
Linda Ejlskov
Mads Phillip Kofoed Grabas
Berit Jamie Nielsen
Christian Torp-Pedersen
Henrik Bøggild
Publication date
01-12-2016
Publisher
BioMed Central
Published in
BMC Gastroenterology / Issue 1/2016
Electronic ISSN: 1471-230X
DOI
https://doi.org/10.1186/s12876-016-0554-9

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