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Dong SXM. Social and natural environmental factors cause the birth-cohort phenomenon of peptic ulcers by superposition mechanism. INTERNATIONAL JOURNAL OF ENVIRONMENTAL HEALTH RESEARCH 2024:1-15. [PMID: 38825775 DOI: 10.1080/09603123.2024.2359069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 05/19/2024] [Indexed: 06/04/2024]
Abstract
The widely believed Helicobacter pylori infection has never explained the birth-cohort phenomenon of peptic ulcers. Although numerous studies have observed that environmental factors are associated with peptic ulcers, their role in the disease has yet to be identified. A new etiological theory proposed that environmental factors cause peptic ulcers via inducing psychological stress. Starting from this etiology, an integration of the mortality rates caused by social and natural environmental factors reproduced a representative fluctuation curve in the birth-cohort phenomenon, where a causal role of environmental factors in peptic ulcers was hidden. The reproduced fluctuation curve revealed that multiple environmental factors caused the birth-cohort phenomenon by Superposition Mechanism, and the causal role of each individual environmental factor surfaced if the fluctuation curves in the birth-cohort phenomenon were properly differentiated. A full understanding of the birth-cohort phenomenon highlights the importance of environmental management in improving clinical outcomes, and suggests that the Superposition Mechanism is an indispensable methodological concept for life science and medicine.
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Affiliation(s)
- Simon Xin Min Dong
- Department of Research and Development, International Institute of Consciousness Science, Vancouver, Canada
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Muazzam A, Ali N, Niazi Y, Hassan N. Emotion regulation, optimism and quality of life among Gastric Ulcer Patients. Pak J Med Sci 2021; 37:988-992. [PMID: 34290771 PMCID: PMC8281170 DOI: 10.12669/pjms.37.4.3894] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 02/22/2021] [Accepted: 03/15/2021] [Indexed: 11/15/2022] Open
Abstract
Objective: The study was aimed to investigate the association among emotion regulation, optimism and quality of life among gastric ulcer patients. Methods: The Cross-sectional study was conducted in public sector hospitals of Lahore, during January-June 2017. Sample of study was comprised of 100 patients diagnosed with gastric ulcer, aged 25-55 years, selected through non-probability purposive sampling technique. Demographic information sheet, Emotion Regulation Scale by John, Gross 2003, Life Orientation Test-Revised by Sheer, Carver 2002, Quality of Life Enjoyment and Satisfaction Questionnaire by Endicott 1993 were used for data collection. SPSS 21 version was used for data analysis. Results: Out of total 100 participants 41 (41%) were men and 59 (59%) were women, with mean age of (M= 44.89, SD= 7.99). There was significant positive correlation among emotion regulation, optimism and quality of life (p<0.01). Optimism and emotion regulation were observed as significant predictors of quality of life (p<0.01). Significant gender differences were found in emotion regulation (p< 0.01), optimism (p< 0.01) and quality of life (p<0.01), with men scoring higher as compared to women. One way ANOVA showed significant differences between emotion regulation, optimism and quality of life among different age groups of gastric ulcer patients (p< 0.01). Conclusion: Quality of life of gastric ulcer patients can be greatly improved by effectively using emotion regulation strategies and optimistic approach.
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Affiliation(s)
- Amina Muazzam
- Dr. Amina Muazzam Tenured Professor, Department of Applied Psychology, Lahore College for Women University (LCWU), Lahore, Pakistan
| | - Nida Ali
- Nida Ali Department of Applied Psychology, Lahore College for Women University (LCWU), Lahore, Pakistan
| | - Yasmeen Niazi
- Yasmeen Niazi Department of Applied Psychology, Lahore College for Women University (LCWU), Lahore, Pakistan
| | - Naima Hassan
- Dr. Naima Hassan Assistant Professor, Department of Psychology, Virtual University of Pakistan, Lahore, Pakistan
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Chaudhury P, Banerjee U. Nature of Anger, Life Event Stress, Conflict and Defense Mechanism Among Individuals Having Peptic Ulcer: A Comparative Study. PSYCHOLOGICAL STUDIES 2020. [DOI: 10.1007/s12646-020-00559-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Lexne E, Brudin L, Marteinsdottir I, Strain JJ, Nylander PO. Psychiatric symptoms among patients with acute abdominal pain. Scand J Gastroenterol 2020; 55:769-776. [PMID: 32603609 DOI: 10.1080/00365521.2020.1782464] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Background: Abdominal pain is a common cause of visits to emergency facilities. It is related to psychiatric disorders in primary care, but it is unclear if this also holds in emergency departments.Objective: Is to explore potential differences between diagnostic groups in patients with acute abdominal pain in an emergency ward regarding concurrent somatic-and psychiatric symptoms, 'Length of stay' (LOS) and perceived health.Method: The patients (N = 137) were divided into three groups; organic dyspepsia, specific abdominal diagnoses, and non-specific abdominal pain. The Prime-MD results for extra gastrointestinal symptoms (outside the gastrointestinal tract), psychiatric symptoms, frequency of symptoms, self-reported health, and LOS within the month before admittance were compared between the diagnostic groups.Results: There was a significant positive correlation between the number of physical extra gastrointestinal and psychiatric symptoms (p < .001), especially regarding anxiety (p < .001) and depression (p = .002). Patients with organic dyspepsia reported significantly more total (p = .016), extragastrointestinal (p = .026) (chest pain; p = .017, dizziness; p = .004, palpitations; p = .005, insomnia; p = .005 and worries; p = .001), and summarized anxiety and depression symptoms (p = .001-0.002) besides poorer general health (p < .001) compared to other abdominal conditions. Also, organic dyspepsia patients needed longer hospital stay than the non-specific abdominal group (p = .002) but similar to the specific abdominal disorders group.Conclusion: Organic dyspepsia is accompanied by more co-occurring physical, anxiety and depression symptoms as well as poorer perceived health than other abdominal pain conditions and comparably increased LOS. This suggests that psychiatric consultations might be beneficial for diagnosing and treating psychiatric comorbidity in emergency care.
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Affiliation(s)
- Erik Lexne
- Department of Clinical and Experimental Medicine, Psychiatry Section, Linköping University, Linkoping, Sweden
| | - Lars Brudin
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | | | - James J Strain
- Icahn School of Medicine at Mount Sinai Mount Sinai Medical Center, New York, NY, USA
| | - Per-Olof Nylander
- Department of Clinical and Experimental Medicine, Psychiatry Section, Linköping University, Linkoping, Sweden
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Dong SXM, Chang CCY, Rowe KJ. A collection of the etiological theories, characteristics, and observations/phenomena of peptic ulcers in existing data. Data Brief 2018; 19:1058-1067. [PMID: 30225279 PMCID: PMC6139371 DOI: 10.1016/j.dib.2018.05.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Revised: 04/22/2018] [Accepted: 05/07/2018] [Indexed: 02/07/2023] Open
Abstract
In this article, we compiled 13 etiological theories, 15 characteristics, and 81 observations/phenomena of peptic ulcers, reported in reproducible, peer-reviewed studies from the literature, to reflect the historical evolution of studies on peptic ulcers and to provide a multidisciplinary view of this disease. This data was collected during the systematic review of topics on peptic ulcers including genetics, etiology, epidemiology, psychology, anatomy, neurology, bacteriology, pathology, and clinical statistics. The data curated herein was extracted via application of recently published basic theories and methodologies.
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Affiliation(s)
- Simon X M Dong
- International Institute of Consciousness Science, Ottawa, Ontario, Canada K2K2K3
| | - Connie C Y Chang
- International Institute of Consciousness Science, Ottawa, Ontario, Canada K2K2K3
| | - Katelynn J Rowe
- International Institute of Consciousness Science, Ottawa, Ontario, Canada K2K2K3
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Draksler K, Dernovšček Hafner N, Arnerić N, Dodič Fikfak M. Restructuring of a Textile Manufacturing Company and Workers' Health. New Solut 2018; 28:131-150. [PMID: 29417871 DOI: 10.1177/1048291118755755] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Organizational restructuring is associated with greater mortality and morbidity of the workers affected by it. We examined the quality of workers' health at a textile manufacturing company after restructuring, comparing three groups of workers: workers who remained (survivors), workers who lost their jobs and later found new jobs (the reemployed), and unemployed workers. A total of 1046 workers participated in a telephonic survey. The data were processed using SPSS and the R package version 1.2 of prLogistic. The differences between groups were calculated using the chi-square test and adjusted prevalence ratios. The comparison between the three groups shows significantly poorer mental health of the unemployed, who more often than survivors and the reemployed reported depression, as well as significant differences in elevated blood pressure, cholesterol level, and cardiac disorders. The reemployed, who were nonetheless in better health compared to the unemployed, reported poor mental health or depression more often in comparison to survivors. Higher morbidity of the unemployed and reemployed could be influenced by numerous factors associated with restructuring.
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Affiliation(s)
- Katja Draksler
- 1 Clinical Institute of Occupational, Traffic and Sports Medicine, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Nataša Dernovšček Hafner
- 1 Clinical Institute of Occupational, Traffic and Sports Medicine, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Niko Arnerić
- 1 Clinical Institute of Occupational, Traffic and Sports Medicine, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Metoda Dodič Fikfak
- 1 Clinical Institute of Occupational, Traffic and Sports Medicine, University Medical Centre Ljubljana, Ljubljana, Slovenia
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Levenstein S, Jacobsen RK, Rosenstock S, Jørgensen T. Mental vulnerability, Helicobacter pylori, and incidence of hospital-diagnosed peptic ulcer over 28 years in a population-based cohort. Scand J Gastroenterol 2017; 52:954-961. [PMID: 28503971 DOI: 10.1080/00365521.2017.1324897] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To examine whether mental vulnerability, an enduring personality characteristic, predicts incident hospital-diagnosed ulcer over three decades. MATERIALS AND METHODS A population-based cohort study enrolled 3365 subjects with no ulcer history, ages 30-60, in 1982-3. Mental vulnerability, Helicobacter pylori IgG antibodies, socioeconomic status, and sleep duration were determined at baseline; non-steroidal antiinflammatory drug use, smoking, leisure time physical activity, and alcohol consumption both at baseline and in 1993-4. Hospital diagnoses of incident ulcer through 2011 were detected using the Danish National Patient Registry. RESULTS Ulcers were diagnosed in 166 subjects, including 83 complicated by bleeding or perforation. Age-, gender-, and socioeconomic status-adjusted associations were significant for mental vulnerability (Hazard Ratio (HR) 2.0, 95% Confidence Interval 1.4-2.8), Helicobacter pylori (HR 1.7, CI 1.2-2.3), smoking (HR 2.0, CI 1.3-3.1), heavy drinking (HR 1.6, CI 1.1-2.4), abstinence (HR 1.6, CI 1.1-2.5), non-steroidal antiinflammatory drugs (HR 2.1, CI 1.5-3.0), and sedentary lifestyle (HR 1.9, CI 1.4-2.7). Adjusted for all behavioral mediators, the HR for mental vulnerability was 1.5 (CI 1.0-2.2, p = .04). Mental vulnerability raised risk in Helicobacter pylori seropositive subjects and those exposed to neither Helicobacter pylori nor non-steroidal antiinflammatory drugs; its impact was virtually unchanged when analysis was limited to complicated ulcers. CONCLUSIONS A vulnerable personality raises risk for hospital-diagnosed peptic ulcer, in part because of an association with health risk behaviors. Its impact is seen in 'idiopathic' and Helicobacter pylori-associated ulcers, and in acute surgical cases.
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Affiliation(s)
- Susan Levenstein
- a Aventino Medical Group , Rome , Italy.,b Research Centre for Prevention and Health, The Capital Region of Denmark , Glostrup , Denmark
| | - Rikke Kart Jacobsen
- b Research Centre for Prevention and Health, The Capital Region of Denmark , Glostrup , Denmark
| | - Steffen Rosenstock
- c Gastroenterology Department , Surgical Section, Hvidovre University Hospital , Copenhagen , Denmark
| | - Torben Jørgensen
- b Research Centre for Prevention and Health, The Capital Region of Denmark , Glostrup , Denmark.,d Department of Public Health, Faculty of Health Science , University of Copenhagen , Copenhagen , Denmark.,e Faculty of Medicine , Aalborg University , Aalborg , Denmark
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Cheng TJ, Guo HR, Chang CY, Weng SF, Li PI, Wang JJ, Wu WS. The Association Between Peptic Ulcer Disease and Ischemic Stroke: A Population-Based Longitudinal Study. Medicine (Baltimore) 2016; 95:e3797. [PMID: 27258514 PMCID: PMC4900722 DOI: 10.1097/md.0000000000003797] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2015] [Revised: 02/11/2016] [Accepted: 04/27/2016] [Indexed: 01/16/2023] Open
Abstract
Stroke is a common cause of death worldwide, but about 30% of ischemic stroke (IS) patients have no identifiable contributing risk factors. Because peptic ulcer disease (PUD) and vascular events share some common risk factors, we conducted a population-based study to evaluate the association between PUD and IS.We followed up a representative sample of 1 million residents of Taiwan using the National Health Insurance Research Database from 1997 to 2011. We defined patients who received medications for PUD and had related diagnosis codes as the PUD group, and a reference group matched by age and sex was sampled from those who did not have PUD. We also collected data on medical history and monthly income. The events of IS occurred after enrollment were compared between the 2 groups. The data were analyzed using Cox proportional hazard models at the 2-tailed significant level of 0.05.The PUD group had higher income and prevalence of hypertension, diabetes mellitus (DM), heart disease, and hyperlipidemia. They also had a higher risk of developing IS with an adjusted hazard ratio of 1.31 (95% confidence interval: 1.20-1.41). Other independent risk factors included male sex, older age, lower income, and co-morbidity of hypertension, diabetes mellitus (DM), and heart disease.PUD is a risk factor for IS, independent of conventional risk factors such as male sex, older age, lower income, and co-morbidity of hypertension, DM, and heart disease. Prevention strategies taking into account PUD should be developed and evaluated.
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Affiliation(s)
- Tain-Junn Cheng
- From the Department of Neurology (T-JC, C-YC); Department of Occupational Medicine (T-JC), Chi Mei Medical Center, Yongkang; Department of Occupational Safety and Disaster Prevention (T-JC), College of Sustainable Environment, Chia Nan University of Pharmacy and Science, Jen-Te; Department of Environmental and Occupational Health (H-RG, P-IL), College of Medicine; Department of Occupational and Environmental Medicine (H-RG), National Cheng Kung University Hospital; Center for General Education (C-YC), Southern Taiwan University, Yongkang, Tainan; Department of Healthcare Administration and Medical Informatics (S-FW), Kaohsiung Medical University, Kaohsiung; Department of Family Medicine (P-IL); Department of Medical Research (J-JW); Department of Internal Medicine (W-SW), Chi Mei Medical Center; and Department of Pharmacy (W-SW), Chia Nan University of Pharmacy and Science, Jen-Te, Tainan, Taiwan
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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. [PMID: 25809417 DOI: 10.1111/apt.13168] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Revised: 11/17/2014] [Accepted: 03/01/2015] [Indexed: 01/24/2023]
Abstract
BACKGROUND Psychosocial stress may influence peptic ulcer disease (PUD) risk, but it can be difficult to identify reliably whether stressful exposures pre-dated disease. The association of stress resilience (susceptibility to stress) with subsequent PUD risk has been incompletely investigated. AIM To assess if stress resilience in adolescence is associated with subsequent PUD risk. METHODS The participants comprised of 233 093 men resident in Sweden, born 1952-1956 and assessed for compulsory military conscription during 1969-1976, with data provided by national Swedish registers. Stress resilience was evaluated through semi-structured interviews by a certified psychologist. Cox regression assessed the association between stress resilience in adolescence and the risk of PUD from 1985 to 2009, between ages 28 and 57 years, with adjustment for parental socioeconomic index, household crowding and number of siblings in childhood, as well as cognitive function and erythrocyte sedimentation rate in adolescence. RESULTS In total, 2259 first PUD diagnoses were identified. Lower stress resilience in adolescence is associated with a higher risk of PUD in subsequent adulthood: compared with high resilience, the adjusted hazard ratios (and 95% CI) are 1.84 (1.61-2.10) and 1.23 (1.09-1.38) for low and moderate stress resilience, respectively. CONCLUSION Stress may be implicated in the aetiology of PUD and low stress resilience is a marker of risk.
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Affiliation(s)
- C Melinder
- Clinical Epidemiology and Biostatistics, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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Leaf Extract ofWasabia japonicaRelieved Oxidative Stress Induced byHelicobacter pyloriInfection and Stress Loading in Mongolian Gerbils. Biosci Biotechnol Biochem 2014; 74:1194-9. [DOI: 10.1271/bbb.90919] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Peptic ulcers after the Great East Japan earthquake and tsunami: possible existence of psychosocial stress ulcers in humans. J Gastroenterol 2013; 48:483-90. [PMID: 23053423 DOI: 10.1007/s00535-012-0681-1] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2012] [Accepted: 09/03/2012] [Indexed: 02/07/2023]
Abstract
BACKGROUND Societal stress derived from an event that affects the whole society, e. g., a natural disaster, provides a unique, indirect way of determining the relationship between psychological stress and peptic ulcer disease in humans. In this study, we investigated the changing patterns of the incidence of peptic ulcers before and after the Great East Japan earthquake, which occurred on 11 March, 2011. METHODS Clinical data of patients with peptic ulcers were retrospectively collected during the 3 months after the earthquake (2011) from 7 major hospitals in the middle of the stricken area, and were compared with the data for the same period of the previous year (2010). The eligible subjects were classified into four groups according to Helicobacter pylori infection status and intake of nonsteroidal anti-inflammatory drugs (NSAIDs). RESULTS The incidence of all types of peptic ulcers was 1.5-fold increased after the earthquake, and in particular, the incidence of hemorrhagic ulcers was 2.2-fold increased; the gastric ulcer/duodenal ulcer ratio in hemorrhagic ulcers was also significantly increased (p < 0.05). Regarding the etiology of the peptic ulcers, the proportion of non-H. pylori and non-NSAID ulcers was significantly increased, from 13 % in 2010 to 24 % in 2011 after the earthquake (p < 0.05). CONCLUSION In addition to the increased incidence of peptic ulcers, compositional changes in the disease were observed after the Great East Japan earthquake. The significant increase in the proportion of non-H. pylori and non-NSAID ulcers after the earthquake indicated that psychological stress alone induced peptic ulcers in humans independently of H. pylori infection and NSAID intake.
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Padol IT, Wang C, Hunt RH. Altered physiology of acid secretion in depression-prone Flinders rats results in exacerbated NSAID and stress-induced gastric damage. Neurogastroenterol Motil 2012; 24:154-63, e89. [PMID: 22082353 DOI: 10.1111/j.1365-2982.2011.01811.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Flinders Sensitive Line (FSL) rats are characterized by hypersensitivity to cholinergic stimuli and have been extensively used for studying depressive disorders. A link between depression and peptic ulcers has long been established; however, there is a lack of data from animal models. METHODS We studied the physiology of acid secretion in FSL and Flinders Resistant Line (FRL) rats in vivo and in vitro. We also examined the susceptibility of Flinders rats to water immersion restraint stress (WIRS) or NSAID-induced gastric damage and explored the effect of an anticholinergic agent, atropine, in reversing this effect. KEY RESULTS Basal acid output was more than twofold greater in FSL compared with FRL rats in vivo, 213.5 and 92.8 μEq/3 h/100 g (P = 0.02), respectively. Carbachol was a more potent secretagog in vitro, and somatostatin was a less potent inhibitory agent, while paradoxically stimulating acid secretion over and above the carbachol response in gastric glands from FSL rats. The FSL rats were more susceptible to indomethacin and WIRS-induced gastric mucosal damage compared with FRL rats. Atropine reduced acid output, which resulted in a reduction in indomethacin and stress-induced gastric damage in FSL rats. CONCLUSIONS & INFERENCES Our study, for the first time, demonstrates that the altered vagally mediated physiology of acid secretion in depression-prone FSL rats contributes to gastric hypersecretion and, consequently, results in exacerbated stress and NSAID-induced gastric damage. Flinders rats may be a useful animal model for studying acid-related and also gastrointestinal functional disorders in depression.
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Affiliation(s)
- I T Padol
- Farncombe Family Digestive Health Research Institute, Division of Gastroenterology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
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Vener KJ, Moore JG, Szabo S, Smolensky MH. Summary and Perspectives: Chronobiology and Ulcerogenesis in 1987. Chronobiol Int 2011. [DOI: 10.1080/07420528709078515] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Abstract
The search for the cause or causes of peptic ulcers has been a long one. It was recognised as early as the 19th Century that damage to the stomach or duodenal bulb was likely to result if the resistance of their mucosae to luminal acid was for some reason impaired. An early theory suggested microscopic vascular occlusion leading to local infarction could be the initiating event but evidence was lacking. Excessive acid secretion is seen in some patients but not in many so is implausible as the main factor in most ulcers. Cigarette smoking is a risk factor and chronic life difficulties has been shown to sometimes play a part, but we would now think that they play only minor roles to possibly tip the balance when a major etiologic factor is already present. The overwhelming evidence now is that the major etiologic factors in chronic peptic ulcer are ingestion of nonsteroidal anti-inflammatory drugs (NSAIDs) and infection with Helicobacter pylori. Understanding the mechanism of the first, and the discovery and demonstration of Koch's postulates for the second, have been instrumental in the award of two Nobel prizes.
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Murray MJ. Review Article: Aetiopathogenesis and treatment of peptic ulcer in the horse: a comparative review. Equine Vet J 2010. [DOI: 10.1111/j.2042-3306.1992.tb04791.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Dursun H, Bilici M, Albayrak F, Ozturk C, Saglam MB, Alp HH, Suleyman H. Antiulcer activity of fluvoxamine in rats and its effect on oxidant and antioxidant parameters in stomach tissue. BMC Gastroenterol 2009; 9:36. [PMID: 19457229 PMCID: PMC2693117 DOI: 10.1186/1471-230x-9-36] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2008] [Accepted: 05/20/2009] [Indexed: 01/11/2023] Open
Abstract
Background Although many drugs are available for the treatment of gastric ulcers, often these drugs are ineffective. Many antidepressant drugs have been shown to have antiulcer activity in various models of experimental ulcer. One such drug, the antidepressant mirtazapine, has been reported to have an antiulcer effect that involves an increase in antioxidant, and a decrease in oxidant, parameters. To date, however, there is no information available regarding the antiulcer activity for a similar antidepressant, fluvoxamine. This study aimed to investigate the antiulcer effects of fluvoxamine and to determine its relationship with antioxidants. Methods Groups of rats fasted for 24 h received fluvoxamine (25, 50, 100 and 200 mg/kg), ranitidine (50 mg/kg) or distilled water by oral gavage. Indomethacin (25 mg/kg) was orally administered to the rats as an ulcerative agent. Six hours after ulcer induction, the stomachs of the rats were excised and an ulcer index determined. Separate groups of rats were treated with the same doses of fluvoxamine and ranitidine, but not with indomethacin, to test effects of these drugs alone on biochemical parameters. The stomachs were evaluated biochemically to determine oxidant and antioxidant parameters. We used one-way ANOVA and least significant difference (LSD) options for data analysis. Results The 25, 50, 100 and 200 mg/kg doses of fluvoxamine exerted antiulcer effects of 48.5, 67.5, 82.1 and 96.1%, respectively, compared to the control rat group. Ranitidine showed an 86.5% antiulcer effect. No differences were observed in the absence of indomethacin treatment for any dose of fluvoxamine or for ranitidine. The levels of antioxidant parameters, total glutathione and nitric oxide, were increased in all fluvoxamine groups and in the ranitidine group when compared with the indomethacin-only group. In addition, fluvoxamine and ranitidine decreased the levels of the oxidant parameters, myeloperoxidase and malondialdeyhyde, in the stomach tissues of the rats when compared to indomethacin group. Conclusion We conclude that fluvoxamine has antiulcer effects, and that these occur by a mechanism that involves activation of antioxidant parameters and inhibition of some toxic oxidant parameters.
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Affiliation(s)
- Hakan Dursun
- Department of Pharmacology, Ataturk University, Faculty of Medicine, Erzurum, Turkey.
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Granö N, Puttonen S, Elovainio M, Virtanen M, Väänänen A, Vahtera J, Keltikangas-Järvinen L, Kivimäki M. Impulsivity as a predictor of newly-diagnosed peptic ulcer disease: A prospective cohort study. PERSONALITY AND INDIVIDUAL DIFFERENCES 2006. [DOI: 10.1016/j.paid.2006.04.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Sugisawa A, Uehata T. Onset of Peptic Ulcer and Its Relation to Work‐Related Factors and Life Events: A Prospective Study. J Occup Health 2006. [DOI: 10.1539/joh.40.22] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Atsuko Sugisawa
- Department of Mental Health Administration StudiesNational Institute of Mental Health, National Center of Neurology and Psychiatry
| | - Tetsunojo Uehata
- Department of Nutrition and Health PromotionInstitute of Public Health
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Jones MP. The role of psychosocial factors in peptic ulcer disease: beyond Helicobacter pylori and NSAIDs. J Psychosom Res 2006; 60:407-12. [PMID: 16581366 DOI: 10.1016/j.jpsychores.2005.08.009] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2005] [Indexed: 12/30/2022]
Abstract
A variety of organic etiologies are associated with peptic ulcer disease, and the most relevant of these are infection with Helicobacter pylori and use of nonsteroidal anti-inflammatory drugs. Between 5% and 20% of patients with gastric or duodenal ulcer, however, lack an identifiable organic etiology. In these patients particularly and in all ulcer patients in general, psychosocial factors may play a significant role. At present, there is no definitive study proving a causal relationship between psychological stress and the development of ulcer disease. Studies to date suffer from significant methodological limitations and have not effectively addressed the poor correlation between ulcer craters and ulcer symptoms. A conservative application of available data would suggest that psychosocial factors play a significant role in symptom perception and reporting in patients with dyspeptic symptoms and may play a role in ulcer formation.
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Affiliation(s)
- Michael P Jones
- Division of Gastroenterology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
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Yeo M, Oh TY, Kim YS, Won YM, Ahn SW, Kim J, Chung SK, Chung MH, Han SU, Hahm KB. Identification of Molecular Targets Associated with Augmented Gastric Mucosal Damages after Stress in the Presence of Helicobacter Pylori Using High Throughput Analysis of cDNA Microarray and Proteomics [Retracted]. J Clin Biochem Nutr 2006. [DOI: 10.3164/jcbn.38.77] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Marie Yeo
- Genome Research Center for Gastroenterology, Ajou University School of Medicine
| | - Tae Young Oh
- Genome Research Center for Gastroenterology, Ajou University School of Medicine
| | - Yong Seok Kim
- Genome Research Center for Gastroenterology, Ajou University School of Medicine
| | | | | | - Jin Kim
- Department of Computer Science and Bioinformatics, Hallym University School of Technology
| | - Soon Ki Chung
- Genome Research Center for Gastroenterology, Ajou University School of Medicine
| | - Myung Hee Chung
- Department of Pharmacology, Seoul National University School of Medicine
| | - Sung Uk Han
- Genome Research Center for Gastroenterology, Ajou University School of Medicine
| | - Ki-Baik Hahm
- Genome Research Center for Gastroenterology, Ajou University School of Medicine
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Abstract
Stress, defined as an acute threat to homeostasis, evokes an adaptive or allostatic response and can have both a short- and long-term influence on the function of the gastrointestinal tract. The enteric nervous system is connected bidirectionally to the brain by parasympathetic and sympathetic pathways forming the brain-gut axis. The neural network of the brain, which generates the stress response, is called the central stress circuitry and includes the paraventricular nucleus of the hypothalamus, amygdala and periaqueductal gray. It receives input from the somatic and visceral afferent pathways and also from the visceral motor cortex including the medial prefrontal, anterior cingulate and insular cortex. The output of this central stress circuit is called the emotional motor system and includes automatic efferents, the hypothalamus-pituitary-adrenal axis and pain modulatory systems. Severe or long-term stress can induce long-term alteration in the stress response (plasticity). Corticotropin releasing factor (CRF) is a key mediator of the central stress response. Two CRF receptor subtypes, R1 and R2, have been described. They mediate increased colonic motor activity and slowed gastric emptying, respectively, in response to stress. Specific CRF receptor antagonists injected into the 0 block these visceral manifestations of stress. Circulating glucocorticoids exert an inhibitory effect on the stress response by receptors located in the medial prefrontal cortex and hippocampus. Many other neurotransmitters and neuroimmunomodulators are being evaluated. Stress increases the intestinal permeability to large antigenic molecules. It can lead to mast cell activation, degranulation and colonic mucin depletion. A reversal of small bowel water and electrolyte absorption occurs in response to stress and is mediated cholinergically. Stress also leads to increased susceptibility to colonic inflammation, which can be adaptively transferred among rats by sensitized CD4(+) lymphocytes. The association between stress and various gastrointestinal diseases, including functional bowel disorders, inflammatory bowel disease, peptic ulcer disease and gastroesophageal reflux disease, is being actively investigated. Attention to the close relation between the brain and gut has opened many therapeutic avenues for the future.
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Affiliation(s)
- Vikram Bhatia
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
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Tejani-Butt S, Kluczynski J, Paré WP. Strain-dependent modification of behavior following antidepressant treatment. Prog Neuropsychopharmacol Biol Psychiatry 2003; 27:7-14. [PMID: 12551720 DOI: 10.1016/s0278-5846(02)00308-1] [Citation(s) in RCA: 123] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The effects of repeated antidepressant drug treatment on behavioral outcome in Wistar Kyoto (WKY) rats, a putative animal model of depressive behavior, were compared to Wistar and Sprague-Dawley (SD) rats. Rats were treated with desipramine (norepinephrine [NE] uptake blocker), nomifensine (NE and dopamine [DA] uptake blocker), paroxetine (serotonin [5-HT] uptake blocker) or saline, for 12 days. On Day 11, rats were tested in the Porsolt forced swim test (FST). On Day 12, rats were tested in the open field test (OFT). Stress reactivity was assessed on Day 13 when all rats were exposed to water-restraint ulcerogenic stress. Significant strain differences in behavioral responses to the drug treatments were observed. Control WKY rats showed the typical freezing behavior in the OFT and excessive floating behavior in the FST as compared to Wistar and SD rats. Desipramine and nomifensine decreased immobility and increased swim time in the FST in WKY rats. Nomifensine reduced response latency in the OFT in WKY rats and increased activity in the OFT in WKY and SD rats. None of the drugs altered the FST in SD rats. Following ulcerogenic stress, desipramine was the only antidepressant that decreased ulcer incidence in all rat strains compared to saline controls. These results suggest that the "depressive behavior" in WKY rats may be modified by antidepressants that alter synaptic levels of NE and/or DA, but not 5-HT.
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Affiliation(s)
- Shanaz Tejani-Butt
- Department of Pharmacology and Toxicology (Box 118), University of the Sciences in Philadelphia, 600 South 43rd Street, Philadelphia, PA 19104, USA.
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Gabry KE, Chrousos GP, Rice KC, Mostafa RM, Sternberg E, Negrao AB, Webster EL, McCann SM, Gold PW. Marked suppression of gastric ulcerogenesis and intestinal responses to stress by a novel class of drugs. Mol Psychiatry 2002; 7:474-83, 433. [PMID: 12082565 DOI: 10.1038/sj.mp.4001031] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2001] [Revised: 09/24/2001] [Accepted: 10/13/2001] [Indexed: 01/23/2023]
Abstract
When exposed to prolonged stress, rats develop gastric ulceration, enhanced colon motility with depletion of its mucin content and signs of physiological and behavioral arousal. In this model, we tested whether antidepressants (fluoxetine and bupropion), anxiolytics (diazepam and buspirone) or the novel nonpeptide corticotropin-releasing hormone (CRH) type-1 receptor (CRH-R1) antagonist, antalarmin, modify these responses. Fluoxetine, bupropion, diazepam and antalarmin all suppressed stress-induced gastric ulceration in male Sprague-Dawley rats exposed to four hours of plain immobilization. Antalarmin produced the most pronounced anti-ulcer effect and additionally suppressed the stress-induced colonic hypermotility, mucin depletion, autonomic hyperarousal and struggling behavior. Intraperitoneal CRH administration reproduced the intestinal but not the gastric responses to stress while vagotomy antagonized the stress-induced gastric ulceration but not the intestinal responses. We conclude that brain CRH-R1 and vagal pathways are essential for gastric ulceration to occur in response to stress and that peripheral CRH-R1 mediates colonic hypermotility and mucin depletion in this model. Nonpeptide CRH-R1 antagonists may therefore be prophylactic against stress ulcer in the critically ill and therapeutic for other pathogenetically related gastrointestinal disorders such as peptic ulcer disease and irritable bowel syndrome.
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Affiliation(s)
- K E Gabry
- Clinical Neuroendocrinology Branch, National Institute of Mental Health, Intramural Research Program, National Institutes of Health, Bethesda, MD 20892-11284, USA
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Abstract
Helicobacter pylori (H. pylori) infection is widely accepted as the most important factor in the pathogenesis of duodenal ulcer. However, in parallel with more effective eradication of H. pylori, the prevalence of H. pylori is changing, and H. pylori-negative peptic ulcer disease appears to be increasing. When making a diagnosis of H. pylori-negative peptic ulcer disease, it is essential to avoid misclassification because of inaccurate diagnosis. In addition, secondary causes may need to be excluded with appropriate investigations. In the absence of H. pylori, nonsteroidal anti-inflammatory drug usage is the most common cause of peptic ulcer; surreptitious nonsteroidal anti-inflammatory drug usage is a cause of unexplained ulcer disease in up to 60% of patients. Hypersecretory syndromes such as Zollinger-Ellison syndrome, although rare, need to be excluded. Once all known etiological factors are excluded, there remains a group of patients with so-called "idiopathic ulcers." The interplay of etiological factors in the pathogenesis of idiopathic peptic ulcer disease is poorly defined but may include a genetic predisposition, altered acid secretion, rapid gastric emptying, defective mucosal defense mechanisms, psychological stress, and smoking. The management of idiopathic peptic ulcers is not defined; they appear to be more resistant to standard therapy, can be associated with more frequent complications, and those that relapse may require long-term maintenance therapy.
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Affiliation(s)
- Carolyn Quan
- Department of Medicine, University of Sydney, Nepean Hospital, Penrith, Australia
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Han KS. The effect of an integrated stress management program on the psychologic and physiologic stress reactions of peptic ulcer in Korea. Int J Nurs Stud 2002; 39:539-48. [PMID: 11996874 DOI: 10.1016/s0020-7489(01)00059-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The purpose of this study was to identify the effects of an integrated stress management program on symptoms of stress and ulcer healing in a sample of Koreans at a major medical center in Seoul, Korea. The study employed an experimental design with two treatment groups. One treatment group (n=23) participated in an integrated stress management program that consisted of seven 1h sessions over a 4-week period. A second treatment group (n=24) was only given a tape on progressive muscle relaxation. Data were collected over a 4-month period on 47 subjects. Participants were randomly assigned to the two treatment groups. Symptoms of stress were measured by the symptoms of stress scale (Kogan, Self-regulation on Stress Reaction by Biofeedback, Korean Psychiatric Academic Society, Korea) translated into Korean. Stage of ulcer healing was evaluated by a physician using an endoscope. Physiologic stress reactions were measured by biofeedback equipment. The integrated stress management program treatment group reported significantly lower stress symptom scores than the progressive muscle relaxation-only group (t=3.66, P<0.001). The integrated stress management group also demonstrated a greater improvement in ulcer healing than the progressive muscle relaxation group (t=1.95, P<0.05). The integrated stress management program was more effective in decreasing self-reported stress symptoms and resulted in a more significant ulcer healing than the progressive muscle relaxation treatment.
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Affiliation(s)
- Kuem Sun Han
- College of Nursing, Korea University, 126-1, Anam Dong 5 Ga, SungBuk Gu, Seoul, South Korea.
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Han KS. The effect of an integrated stress management program on the psychologic and physiologic stress reactions of peptic ulcer in Korea. J Holist Nurs 2002; 20:61-80. [PMID: 11898689 DOI: 10.1177/089801010202000106] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The purpose of this study was to identify the effects of an integrated stress management program on symptoms of stress and ulcer healing in a sample of Koreans at a major medical center in Seoul. The study employed an experimental design with two treatment groups. One treatment group (n = 23) participated in an integrated stress management program (ISMP) that consisted of seven 1-hour sessions over a 4-week period. A second treatment group (n = 24) was only given a tape on progressive muscle relaxation (PMR). The ISMP treatment group reported significantly lower stress symptom scores than the PMR only group (t = 3.66, p < .001). The ISMP group also demonstrated greater improvement in ulcer healing than the PMR group (t = 1.95, p < .05). The integrated stress management program was more effective in decreasing self-reported stress symptoms and resulted in more significant ulcer healing than the progressive muscle relaxation treatment.
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Nomura M, Yukinaka M, Miyajima H, Nada T, Kondo Y, Okahisa T, Shibata H, Okamura S, Honda H, Shimizu I, Saito K, Oki T, Nakaya Y, Ito S. Is autonomic dysfunction a necessary condition for chronic peptic ulcer formation? Aliment Pharmacol Ther 2000; 14 Suppl 1:82-6. [PMID: 10807408 DOI: 10.1046/j.1365-2036.2000.014s1082.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
Abstract
BACKGROUND The relationship between 1/f fluctuation of the heart rate variability and Helicobacter pylori infection was evaluated, in order to clarify whether autonomic nervous dysfunction is a necessary condition for chronic peptic ulcer formation. METHODS The subjects were 11 patients with recurrent chronic peptic ulcer and 20 age-matched normal subjects. Holter ECGs were recorded over 24 h, and the 1/f(-x) fluctuation of the heart rate was computed. The 1/f(-x) fluctuation of the heart rate is a novel index of autonomic function that has been shown to reflect a patient's pleasant mood. For 1/f(-x) fluctuation, the slope of the regression line (-x) was determined and cosine fitting of the absolute slope of the regression line over a 24-h period was performed. RESULTS For the normal group, the absolute slope of the regression line during daytime and night-time were 0.53 +/- 0.16 and 1.05 +/- 0.18, respectively. For the peptic ulcer group, the corresponding values during daytime and night-time were 0.94 +/- 0.15 and 1.84 +/- 0.18, respectively. The mean value of the cosine curve was 0.76 +/- 0.23 in the normal group and 1.12 +/- 0.25 in the peptic ulcer group. Thus, these values were significantly higher for the latter group than for the former group (P<0.05). No statistically significant difference in H. pylori infection between the two groups was observed. CONCLUSIONS Autonomic nervous dysfunction as well as H. pylori infection appears to be a necessary condition for chronic peptic ulcer formation.
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Affiliation(s)
- M Nomura
- Second Department of Internal Medicine, School of Medicine, University of Tokushima, Japan.
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Abstract
OBJECTIVE Research on ulcer psychosomatics has plummeted since the early 1970s, to the applause of many who argue that ulcer is simply an infectious disease. The purpose of this article is to discuss the relevance of ulcer psychogenesis in the age of Helicobacter pylori. METHODS A critical literature review was conducted. RESULTS There is a substantial and methodologically sound body of prospective studies linking stress with the onset and course of peptic ulcer. Psychosocial factors can be estimated to contribute to 30% to 65% of ulcers, whether related to nonsteroidal antiinflammatory drugs, H. pylori, or neither. The observed association between stress and ulcer is accounted for, in part, by recall bias, misreported diagnoses, and confounding by low socioeconomic status (a source of stress and of ulcer risk factors, such as H. pylori and on-the-job exertion) and by distressing medical conditions (which lead to use of nonsteroidal antiinflammatory drugs). Of the residual, true association, a substantial proportion is accounted for by mediation by health risk behaviors, such as smoking, sleeplessness, irregular meals, heavy drinking, and, again, nonsteroidal antiinflammatory drugs. The remainder results from psychophysiologic mechanisms that probably include increased duodenal acid load, the effects of hypothalamic-pituitary-adrenal axis activation on healing, altered blood flow, and impairment of gastroduodenal mucosal defenses. CONCLUSIONS Peptic ulcer is a valuable model for understanding the interactions among psychosocial, socioeconomic, behavioral, and infectious factors in causing disease. The discovery of H. pylori may serve, paradoxically, as a stimulus to researchers for whom the concepts of psychology and infection are not necessarily a contradiction in terms.
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Affiliation(s)
- S Levenstein
- Gastroenterology Department, San Camillo-Forlanini Hospital, Rome, Italy.
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Yukinaka M, Nomura M, Saijyo T, Nada T, Miyajima H, Kondo Y, Saito K, Nakaya Y, Ito S. Evaluation of autonomic nervous function in patients with essential hypertension complicated with peptic ulcer. J Gastroenterol Hepatol 2000; 15:40-4. [PMID: 10719746 DOI: 10.1046/j.1440-1746.2000.02052.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIMS The relationship between peptic ulcer, autonomic activity and the incidence of Helicobacter pylori infection in untreated hypertensive patients complicated with peptic ulcer were evaluated. METHODS Ten hypertensive patients with peptic ulcer (HT-PU group), 15 untreated essential hypertensive patients without peptic ulcer (HT group) and 10 normal subjects (N group) were enrolled, and a power spectral analysis was performed in each subject. A biopsy urease test was used to detect infection by H. pylori. RESULTS No significant differences were observed in the values of mean low-frequency (LF) power between the three groups. However, the mean high-frequency (HF) power in the HT-PU group was significantly greater than those of the HT and N groups (P<0.01). The mean LF/HF ratios in the HT-PU and HT groups were significantly greater than that of the N group (P<0.01). With respect to H. pylori infection, no significant differences between the three groups were observed. Sympathetic activity (LF power) was increased in the HT and HT-PU groups. Furthermore, parasympathetic activity (HF power) was increased in the HT-PU group. CONCLUSIONS These findings suggest the participation of increased parasympathetic activity in peptic ulcer patients. Therefore, it is suggested that new techniques, such as spectral analysis of heart rate variability, as used in this study, will clarify the relationship between peptic ulcer and autonomic nervous function.
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Affiliation(s)
- M Yukinaka
- Second Department of Internal Medicine, School of Medicine, University of Tokushima, Japan
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Matsushima Y, Aoyama N, Fukuda H, Kinoshita Y, Todo A, Himeno S, Fujimoto S, Kasuga M, Nakase H, Chiba T. Gastric ulcer formation after the Hanshin-Awaji earthquake: a case study of Helicobacter pylori infection and stress-induced gastric ulcers. Helicobacter 1999; 4:94-9. [PMID: 10382122 DOI: 10.1046/j.1523-5378.1999.98290.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Both Helicobacter pylori (H. pylori) infection and various stresses are known to induce peptic ulcer disease of the upper gastrointestinal tract. However, the pathogenetic relationship between the two factors has not yet been clarified. We conducted a case-control study to examine whether H. pylori infection played a role in the development of gastric ulcer (GU) induced by life-event stresses that were experienced after the Hanshin-Awaji earthquake. MATERIALS AND METHODS Serum samples from patients in the devastated area who developed GUs during the 2 months following the Hanshin-Awaji earthquake and those from GU patients in the same area during the corresponding period of the previous year, and from gender-, age- and institute-matched ulcer-free controls were tested for the presence of the H. pylori IgG antibody. RESULTS A significant association between H. pylori infection and the development of GU in uninjured patients was observed in all sets [matched odds ratio (OR) = 3.23, 95% confidence interval: 1.95-5.35]. Moreover, the prevalence of H. pylori infection in patients who developed GUs after the earthquake was not different from that for GU patients in the previous year. In contrast, there was no association between H. pylori infection and the development of GU in the physically injured patients after the earthquake. CONCLUSIONS H. pylori infection may play an important role in the development of GUs that are induced by emotional life-event stresses.
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Affiliation(s)
- Y Matsushima
- Fourth Department of Internal Medicine, Kobe University School of Medicine, Japan
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Aoyama N, Kinoshita Y, Fujimoto S, Himeno S, Todo A, Kasuga M, Chiba T. Peptic ulcers after the Hanshin-Awaji earthquake: increased incidence of bleeding gastric ulcers. Am J Gastroenterol 1998; 93:311-6. [PMID: 9517630 DOI: 10.1111/j.1572-0241.1998.00311.x] [Citation(s) in RCA: 62] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Although physical stresses are known to induce peptic ulcers in the upper gastrointestinal tract, it remains controversial whether emotional stress can cause peptic ulcers. Therefore, we examined retrospectively the influence of the Hanshin-Awaji earthquake that occurred in Japan in January 1995 on the occurrence of peptic ulcer disease among noninjured residents. METHODS Sixty-one hospitals, covering 70% of all endoscopy examinations performed in this area, joined the study and were divided into three areas according to the severity of the damage. A comparison was made between a group of 10,831 patients who underwent upper gastrointestinal endoscopy within 2 months after the earthquake and 16,100 who did so in the same hospitals during the corresponding period in 1994. RESULTS In the most devastated area, in spite of a dramatic decrease in the total number of endoscopies (50.0%), patients with gastric ulcer (GU) were increased in 1995, whereas those with duodenal ulcer were decreased, resulting in a higher ratio of gastric to duodenal ulcers than in 1994 (3.07 vs 1.88). In particular, there was a marked increase in bleeding GU. The mean age of patients with GU was significantly higher in 1995 than in 1994. CONCLUSION The Hanshin-Awaji earthquake-induced life event stress not only triggered but also exacerbated GU, particularly in the elderly.
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Affiliation(s)
- N Aoyama
- Second Department of Internal Medicine, Kobe University School of Medicine, Japan
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Levenstein S, Kaplan GA, Smith MW. Psychological predictors of peptic ulcer incidence in the Alameda County Study. J Clin Gastroenterol 1997; 24:140-6. [PMID: 9179731 DOI: 10.1097/00004836-199704000-00004] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
It has often been suggested that mood and personality predispose to peptic ulcer, but little prospective evidence exists. We used longitudinal data from the Alameda County Study to seek associations of psychological characteristics with later ulcer development, taking into account the possible confounding or mediating, taking into account the possible confounding or mediating roles of nonpsychological factors. Among 4,595 Alameda County Study subjects ulcer-free in 1965, we studied five baseline psychological measures (depression, hostility, ego resiliency, social alienation or anomy, and personal uncertainty) with respect to reported ulcer in 1973-1974. All five measures had significant age-adjusted associations with incident ulcer [odds ratio (O.R.) 1.8-2.6]. After adjustment for smoking, drinking, skipping breakfast, lack of sleep, painful medical conditions, and liver disease, three measures remained significant: depression, anomy, and hostility. The age-adjusted O.R. of 2.8 [95% confidence interval (C.I.) 1.6, 4.8] for an upper versus a lower tertile index of independently predictive psychological factors fell to 2.1 with adjustment for health-related behaviors and medical conditions, and reached 1.7 (C.I. 1.0, 3.1) after addition of education to the model. We conclude that depression, maladjustment, and hostility are prospectively associated with peptic ulcer. These associations are partially accounted for by confounding or mediation by standard risk factors, and are to some extent related to socioeconomic status.
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Affiliation(s)
- S Levenstein
- Human Population Laboratory, Berkeley, California, USA
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Fukunishi I, Kaji N, Hosaka T, Berger D, Rahe RH. Relationship of alexithymia and poor social support to ulcerative changes on gastrofiberscopy. PSYCHOSOMATICS 1997; 38:20-6. [PMID: 8997112 DOI: 10.1016/s0033-3182(97)71499-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The effects of psychosocial factors on peptic ulceration and/or erosions were examined in a sample of 189 volunteers. Analysis of variance found that the severity of gastrofiberscopic findings was related to two psychosocial factors-poor social support and degree of alexithymia- and that both psychosocial factors were significantly correlated with one another. Analysis of covariance indicated that gastrofiberscopic findings remained significantly related to poor social support when alexithymia was controlled for. These findings suggest that in both healthy persons, and in persons with alexithymia, peptic ulceration or erosions tend to manifest when social support is low. Poor social support and alexithymia may be an especially high-risk combination for the development of peptic ulceration and/or erosions.
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Levenstein S, Prantera C, Varvo V, Arca M, Scribano ML, Spinella S, Berto E. Long-term symptom patterns in duodenal ulcer: psychosocial factors. J Psychosom Res 1996; 41:465-72. [PMID: 9032710 DOI: 10.1016/s0022-3999(96)00196-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Seventy-five patients with recent-onset dyspepsia and endoscopically visible duodenal ulcer underwent psychological evaluation. Following ranitidine treatment, they were reinterviewed periodically for 12 to 76 months (mean 38.6). Ulcer symptoms were present during a mean of 14.9% of follow-up months. Patients did significantly worse if they had a low-status occupation, low education, depression, stressful life events, or abnormal Minnesota Multiphasic Personality Inventory at baseline. Of patients recalling premorbid life stress, those with a normal MMPI had a particularly benign course, whereas those with an abnormal MMPI did particularly poorly (6% versus 29% of months symptomatic: p < 0.04). Age, gender, smoking, drinking, antiinflammatory drugs, pepsinogen, Helicobacter pylori titers, and initial healing had no prognostic effect. Low socioeconomic status, life stress, depression, and psychopathology each predict a relatively poor symptom outcome for duodenal ulcer treated with antisecretory therapy, but psychologically stable individuals who develop an ulcer under stress have an excellent long-term prognosis.
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Affiliation(s)
- S Levenstein
- Gastroenterology Division, Nuovo Regina Margherita Hospital, Rome, Italy
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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. [PMID: 8742643 DOI: 10.1097/00004836-199603000-00002] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
We investigated psychologic influences on duodenal ulcer by examining the effect of personality, stress, and mood, measured at diagnosis, on subsequent ulcer healing. Stressful life events, psychopathology (assessed using the Minnesota Multiphasic Personality Inventory), anxiety, depression, smoking, alcohol consumption, nonsteroidal antiinflammatory drug use, and serum pepsinogen I levels were determined immediately after endoscopy showed duodenal ulcer craters in 70 patients with recent onset of symptoms. Endoscopy was repeated following 6 weeks of ranitidine therapy. Six ulcers (8.6%) persisted, and the duodenum remained inflamed in an additional five cases, for a total of 16% with incomplete healing. The only baseline characteristic significantly associated with poor healing was anxiety (p = 0.03 for ulcer persistence, p = 0.02 for incomplete healing). Being in the highest anxiety tertile was associated with a more than fourfold elevation in the risk of incomplete healing (p = 0.02). The association between anxiety and poor healing was not changed by modification of the anxiety score to eliminate gastrointestinal symptom items or by adjustment for serum pepsinogen, sex, or cigarette smoking. Anxiety inhibits the healing of duodenal ulcers treated with adequate antisecretory therapy.
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Affiliation(s)
- S Levenstein
- Gastroenterology Division, Nuovo Regina Margherita Hospital, Rome, Italy
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Glavin GB, Alvarez I, Colombo M, Farré AJ. Effects of a novel 5-HT1A receptor agonist, E4424, on gastric adherent mucus levels following restraint stress in rats. Dig Dis Sci 1995; 40:2317-20. [PMID: 7587808 DOI: 10.1007/bf02063231] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Several novel arylpiperazine serotonin 1A receptor agonists, developed as anxiolytics, have antisecretory and gastroprotective effects in rats. E4424 (2-¿4-[4-(4-chloropyrazol-1-yl)butyl]-1-piperazinyl ¿pyrimidine; Lesopitron dihydrochloride), has potent anti-gastric secretory and antiulcer effects. Preliminary data indicated an enhancing effect of E4424 on gastric mucus that may underlie its gastroprotective actions. We therefore tested the effects of acute and chronic administration of E4424 and of a reference 5-HT1A receptor agonist, 8-OHDPAT [8-hydroxy-2-(di-n-propylamino)tetralin], on gastric mucus levels in rats subjected to cold-restraint stress, a procedure associated with depletion of gastric mucus and the development of mucosal injury. Acute oral administration of E4424 increased adherent mucus levels by 12%, 11%, and 13%, relative to controls. Chronic E4424 significantly increased gastric mucus relative to controls (69% increase). Acute oral treatment with 8-OHDPAT did not affect gastric mucus level. Acute intraperitoneal 8-OHDPAT slightly increased mucus levels. Chronic twice per day 8-OHDPAT did not affect mucus levels; however, chronic once per day treatment with 8-OHDPAT significantly elevated gastric mucus levels at the highest doses used. For E4424, there is a strong correlation between reduction of gastric mucosal injury and increase in gastric mucus level, suggesting that the action of E4424 on glandular mucus levels is an important mechanism underlying its gastroprotective effects.
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Affiliation(s)
- G B Glavin
- Department of Pharmacology and Therapeutics, Faculty of Medicine, University of Manitoba, Winnipeg, Canada
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Abstract
To examine the relationship between society stress and peptic ulcer perforation, time-trend analysis was performed on the annual incidence of perforated peptic ulcer per 100,000 population in Hong Kong during the years 1962-85, when Hong Kong, as a developing city, went through significant socio-economic and political changes, and the trend was correlated with specially designed and validated society stress scores estimated annually during the same period. The society stress scores were derived independently by two expert panels blinded to the purpose of the study, one selecting and categorizing negative news events for Hong Kong during this period, and the other weighing the categories and scoring the impact of the news on Hong Kong. The incidence of perforation increased significantly during the years and manifested three distinct peaks, which coincided with the worst economic recession in Hong Kong, the influx of mainlander Chinese and Vietnamese boat people, and the Sino-British negotiation on the sovereignty of Hong Kong after 1997. Both linear and autoregression analysis, the latter taking into consideration point fluctuations in rates, showed that perforation rates correlated significantly with the society stress scores (r = 0.57, P < 0.002). The peak effects and the significant correlations indicate that an association exists between society stress and peptic ulcer perforation, and suggest that chronic society stress plays an important role in the aetiology of this condition, although the relatively low r value also suggests the presence of other aetiological factors.
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Affiliation(s)
- S K Lam
- Department of Medicine, University of Hong Kong
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42
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Abstract
Duodenal ulcer (DU) is a common medical disorder which frequently becomes chronic. The factors involved in the aetiology of DU are poorly understood. Evidence for the contribution of psychosocial factors to the onset of DU is reviewed in the context of evidence of organic factors, genetic and environmental, with special reference to new evidence of infectious agents in the aetiology of DU. Recent progress in understanding of biological forces of duodenal ulcer disease has lead to a substantially revised view of psychosomatic factors. Although these may be of significance, their relative contribution to aetiology is likely to be modest.
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Affiliation(s)
- J Lewin
- University Department of Psychiatry, Royal Free Hospital School of Medicine, London, U.K
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Abstract
Higher rates of psychiatric comorbidity as well as more impaired psychosocial adjustment occur with the functional bowel disorders and are particularly high in self-selected referral patients compared with community populations. Reciprocally, some studies show higher rates of functional bowel disturbances in patients with psychiatric diagnoses. Remaining alert for and addressing coexisting psychiatric illness will enhance treatment outcome (increased patient compliance, functioning, and satisfaction). Additionally, psychological factors affect the clinical expression of structural disease. Resetting treatment goals from cure to coping with chronic illness and setting personal limits are important.
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Affiliation(s)
- A Fullwood
- Department of Medicine, University of North Carolina, Chapel Hill 27599-7080, USA
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Disorders of the gut. Health Psychol 1995. [DOI: 10.1007/978-1-4899-3226-6_13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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45
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Hales TR, Sauter SL, Peterson MR, Fine LJ, Putz-Anderson V, Schleifer LR, Ochs TT, Bernard BP. Musculoskeletal disorders among visual display terminal users in a telecommunications company. ERGONOMICS 1994; 37:1603-1621. [PMID: 7957018 DOI: 10.1080/00140139408964940] [Citation(s) in RCA: 112] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
The relationship between workplace factors and work-related upper extremity musculoskeletal disorders (UE disorders) was assessed in a cross-sectional study of 533 telecommunication employees utilizing video display terminals (VDTs). Cases of UE disorders were defined using symptom questionnaires and physical examinations. Data on demographics, individual factors (medical conditions and recreational activities), work organization and practices, and psychosocial aspects of work, including electronic performance monitoring (EPM), were obtained by questionnaire. Associations between workplace factors and UE disorders were assessed by multiple logistic models generated for each of the four UE areas (neck, shoulder, elbow, hand/wrists). One-hundred and eleven (22%) participants met our case definition for UE disorders. Probable tendon-related disorders were the most common (15% of participants). Probable nerve entrapment syndromes were found in 4% of participants. The hand/wrist was the area most affected, 12% of participants. The following variables had associations in the final models (p < 0.05) with at least one of the four UE disorders, although the strength of these associations were modest. Non-white race, a diagnosis of a thyroid condition (self-reported) use of bifocals at work, and seven psychosocial variables (fear of being replaced by computers, increasing work pressure, surges in workload, routine work lacking decision-making opportunities, high information processing demands, jobs which required a variety of tasks and lack of a production standard) were associated with UE disorders. This study indicates that work-related UE musculoskeletal disorders are relatively common among telecommunication workers who use VDTs, and adds to the evidence that the psychosocial work environment is related to the occurrence of these disorders.
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Affiliation(s)
- T R Hales
- National Institute for Occupational Safety and Health, Cincinnati, Ohio 45226
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46
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Abstract
OBJECTIVES To investigate the direction of a possible relationship between peptic ulcer disease and personality disorders. DESIGN A cohort study of 50-year old patients, observed for 2 decades. SETTING Glostrup County, Denmark (population 100000). SUBJECTS A representative sample of 50-year old people born in 1914 (n = 673) were followed for 20 years. All 673 filled in the Minnesota Multiphasic Personality Inventory (MMPI) in 1964 and 513 were retested with MMPI in 1974. MAIN OUTCOME MEASURES Prevalence of peptic ulcer disease 1964, incidence of peptic ulcer disease 1964-84, MMPI scores. RESULTS The prevalence of peptic ulcer disease in 1964 was 7% and the average annual incidence in the period 1964-84 was 2.1 per 1000 persons. Those with incidental peptic ulcer in 1964-84 had normal MMPI scores in 1964, whilst those with peptic ulcer in 1964 had a slight but statistically significant increase in one neuroticism scale (HS) only. The group with prevalent ulcer disease in 1974 exhibited statistically significant increases in the three neuroticism scales (HS, D, HY) and in scale Pd and scale Pt at MMPI retesting. In addition they had statistically significantly higher scores in the three neuroticism scales compared with the other persons who still had normal scores in all scales. CONCLUSIONS Personality disorders in patients with peptic ulcer are consequences of the disease and not causal factors.
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Affiliation(s)
- P Jess
- Department of Surgical Gastroenterology, Herlev Hospital, University of Copenhagen, Denmark
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Jess P, Eldrup J. The personality patterns in patients with duodenal ulcer and ulcer-like dyspepsia and their relationship to the course of the diseases. Hvidovre Ulcer Project Group. J Intern Med 1994; 235:589-94. [PMID: 8207365 DOI: 10.1111/j.1365-2796.1994.tb01266.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVES To compare personality characteristics in duodenal ulcer patients and patients with ulcer-like dyspepsia from the primary health sector with duodenal ulcer patients from a hospital and to evaluate the relationship of the personality characteristics to the course of the diseases. DESIGN A prospective study using the Minnesota Multiphasic Personality Inventory (MMPI) with retesting of a subgroup of patients after a median observation period of 14 months. SETTING Departments of Medical and Surgical Gastroenterology, Hvidovre University Hospital, and the primary health sector in Roskilde County, Denmark. SUBJECTS Sixty hospital patients with duodenal ulceration and 17 patients with duodenal ulceration plus 25 patients with ulcer-like dyspepsia from the primary health sector. MAIN OUTCOME MEASURES MMPI scores. RESULTS The hospital patients differed from the two other groups of patients by having higher scores of depression and anxiety (P < 0.05). Twenty-eight of the patients were retested with MMPI. Contrary to the patients with persisting complaints, abnormal personality characteristics disappeared in patients without complaints (P < 0.05-0.001). CONCLUSIONS The results indicate that abnormal personality characteristics in patients with functional and organic upper dyspepsia are consequential rather than causal factors.
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Affiliation(s)
- P Jess
- Department of Medical, Gastroenterology, Hvidovre University Hospital, Denmark
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Shiu LP, Hui WM, Lam SK. Negative social events, stress, and health in Hong Kong. J Epidemiol Community Health 1993; 47:181-5. [PMID: 8350028 PMCID: PMC1059762 DOI: 10.1136/jech.47.3.181] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
STUDY OBJECTIVE To investigate the association, if any, between negative social events and physical illness. DESIGN Comparison of major social events and indices of disease. SETTING-Hong Kong, 1962 to 1985. SUBJECTS Patients treated in hospital for attempted suicide, coronary heart disease, and diabetes mellitus. MEASUREMENTS AND MAIN RESULTS Major events were selected from the annual Hong Kong Year Book, and grouped in one of 18 categories by a panel of 10 assessors. Weights were assigned to each category according the likely stress produced. Individual events were then scored and multiplied by the category weights to produce an overall stress score from which a total stress score for each year was derived. Annual stress scores were then compared with hospital attendance rates for the three medical conditions. CONCLUSIONS The study has shown that: (1) the stress induced in the community by major negative social events in Hong Kong had been increasing; and (2) this stress is associated with attempted suicide but not with diabetes mellitus or coronary heart disease.
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Affiliation(s)
- L P Shiu
- Department of Medicine, University of Hong Kong, Queen Mary Hospital
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49
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Hernandez DE, Arandia D, Dehesa M. Rôle of psychosomatic factors in peptic ulcer disease. JOURNAL OF PHYSIOLOGY, PARIS 1993; 87:223-7. [PMID: 8136788 DOI: 10.1016/0928-4257(93)90009-i] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Evidence indicates that a link between peptic ulcer disease (PUD) and selected psychosomatic factors may exist. A series of 70 consecutive male and female adult patients were categorized by peptic symptoms and divided into four groups: a) controls; b) gastric ulcer (GU); c) duodenal ulcer (DU); and d) chronic non-ulcer dyspepsia (CNUD). All patients were interviewed and asked to answer a questionnaire that included demographics, medical history and the incidence of negative life events. A decreased level of activity was a predominant finding in GU, DU and CNUD patients. Family history of PUD may be correlated with CNUD. Of interest was the finding that DU and CNUD patients presented a higher incidence of negative life events when compared to the other study groups. Negative life events that produce considerable stress may predispose to peptic symptoms in certain patients.
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Affiliation(s)
- D E Hernandez
- Department of Medicine, Los Angeles County-University of Southern California School of Medicine 90033
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50
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Glavin GB. Vulnerability to stress ulcerogenesis in rats differing in anxiety: a dopaminergic correlate. JOURNAL OF PHYSIOLOGY, PARIS 1993; 87:239-43. [PMID: 7907912 DOI: 10.1016/0928-4257(93)90011-h] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Dopamine and its agonists, acting through D1/DA1 receptors, have been shown to be effective protective factors against stress ulcerogenesis. Since anxiety has been related to stress ulcer development, we chose to examine dopaminergic activity in rats screened for the extremes of behaviorally manifest anxiety. High anxious rats develop more stress ulcers and more ethanol ulcers, relative to low anxious animals. High anxious rats require greater amounts of dopaminergic agonists for 50% protection against stress ulcer formation. In conditions of exposure to a stressor, high anxious rats lose amygdalar dopamine at a faster rate than do low anxious rats. These results suggest that anxiety is a significant factor in stress ulcer development and that central dopaminergic function is critically involved in mediating this pathogenetic factor.
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Affiliation(s)
- G B Glavin
- Department of Pharmacology and Therapeutics and Surgery, Faculty of Medicine, University of Manitoba, Winnipeg, Canada
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