Stress as the cause of a stomach ulcer?
In general, a peptic ulcer is caused by an imbalance between the stomach‘s protective factors and the attacking substances. Stress alone, however, cannot lead to the development of a peptic ulcer. Nevertheless, it is possible that a lot of and continuous stress in combination with an unhealthy diet, alcohol and smoking can lead to an inflammation of the mucous membranes of the stomach and thus cause a stomach ulcer.
The reason for this is that these factors lead to increased acid production in the stomach. This attacks the stomach lining and can lead to inflammation of the mucous membrane. In addition, the sympathetic nervous system is activated under stress.
This sets the body to flee and fight and stops the intestinal activities. Thus, on the one hand, stomach pain can be caused by stress, constipation or diarrhoea, but also increased acid production. The medically titled stress ulcer (peptic ulcer caused by stress), however, does not refer to everyday stress as its cause, but rather to previous major operations, massive burns, polytrauma, sepsis or shock.
There is reduced blood circulation in the stomach and increased production of gastric acid. Both lead to inflammation of the mucous membranes and can cause a stomach ulcer. As this complication is known and occurs in the context of life-threatening diseases, the stress ulcer can be prevented by medication. Proton pump inhibitors or other drug-based acid blockers can be used. These prevent increased acid production and thus the development of a stress ulcer.
Diagnosis peptic ulcer
The diagnosis of a peptic ulcer is made using various diagnostic instruments:
- Patient consultation
- X-ray Breischluck
- Gastroscopy (gastroscopy)
- Urease test
- 13C-urea breath test
First indications of the underlying disease of the stomach ulcer are given in the patient interview (anamnesis) in which typical symptoms, medication (NSAR ?, aspirin ? etc) are asked.During the physical examination a pressure painful upper abdomen may be noticed. In the laboratory, a low hemoglobin value may indicate anemia and thus an ulcer bleeding or stomach bleeding.
Invisible “occult” blood can be detected in the stool test (haemocult test). False positive results of the haemocult test may be caused by taking certain drugs (e.g. iron preparations) or food. However, the final diagnosis of peptic ulcer is only made in a gastroscopy.
In this peptic ulcer diagnosis, the stomach area is X-rayed while the patient swallows an X-ray contrast medium. The contrast medium fills the stomach so that the surface condition (relief) of the stomach lining can be assessed. This examination is mainly carried out on patients who refuse to undergo a gastric mirroring or on patients who cannot undergo a gastric mirroring.
The ulcers typically appear as niches in the relief of the stomach wall in which contrast medium collects. However, this examination method is not the method of choice for diagnosing stomach ulcers because not all ulcers are detected and, in addition, ulcers cannot be distinguished from stomach cancer (gastric carcinoma). The examination is particularly valuable in cases of suspected gastric outlet stenosis.
X-ray images typically show a narrowing that looks like an hourglass silhouette. This constriction is therefore also called “hourglass stomach”. Mirroring” (endoscopy) of the stomach and duodenum is the method of choice for the direct assessment and classification of mucous membrane damage and should be performed if a stomach or duodenal ulcer is suspected.
During this examination, images are transmitted to a monitor via a tube camera (endoscope). During the endoscopy, tissue samples (biopsy) can also be taken from suspicious areas of the mucous membrane. At least six tissue samples should be taken from an ulcer in order not to miss a tumor (carcinoma) of the stomach, which sometimes cannot be distinguished from an ulcer during endoscopy.
Tissue assessment under the microscope (histological findings) is far more meaningful than the (macroscopic) findings seen with the naked eye. In addition, a piece of tissue can be used to perform the urease test. The urease test is used to detect the bacterium Helicobacter pylori.
In this diagnosis of gastric ulcer, the removed piece of tissue is placed in a special medium for 3 hours. In this medium, only Helicobacter pylori can produce ammonia from the bacteria‘s own enzyme urease and the medium changes color. This is a quick and cheap way to detect Helicobacter pylori infection in the stomach lining.
This test can also detect the bacterium Helicobacter pylori. The patient is administered a 13C-labelled urea (radioactively labelled) orally via a drink. The patient must then exhale strongly through a straw into a special glass tube.
By splitting this urea into CO2 and ammonia by the bacteria, the amount of the labeled 13C in the exhaled CO2 can be measured. This procedure, which is not quite cheap, can be used to check the success of an antibiotic therapy against Helicobacter pylori (eradication therapy). The advantage of this test is that it is non-invasive, i.e. it does not interfere with the patient’s body and is therefore almost free of complications.
In the case of ulcers that are resistant to treatment (ulcers), additional diagnostics should always be arranged in order to reliably rule out stomach cancer (gastric cancer) or rare ulcer diseases. If there are uncertainties regarding stomach cancer (gastric cancer), a second gastroscopy with renewed tissue sampling and examination can provide additional certainty. To exclude rare causes of ulcers, the gastrin level in the blood is measured to rule out a Zöllinger-Ellisson syndrome or the calcium in the blood is examined to detect hyperparatyroidism (functional disorder of the parathyroid gland). Causes of resistance to treatment can also be rare strains of Helicobacter for which the usual antibiotic therapy is not effective or an inflammatory bowel disease, such as Crohn’s disease or a Herpes Simplex virus infection.
