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PubMed1987

Is duodenal ulcer really a psychosomatic disease? A population-based case-control study.

Risk factors for prepyloric and duodenal ulcer were analysed by means of a questionnaire in 132 patients and 132 population controls, pairwise matched for age and sex. Several factors associated with a lower socioeconomic status, such as short education, low income and low housing standard, and a job characterized by low satisfaction, low demands, and low autonomy, were more prevalent among the patients. The odds ratio (OR) with 95% confidence limits (CL) in smokers versus non-smokers was 2.9 (CL, 1.7-5.0). A trend emerged in relation to the daily number of cigarettes, with an OR of 4.1 (CL, 2.2-7.5) for those smoking more than 10 cigarettes. The risk of having peptic ulcer disease was virtually unrelated to other psychiatric and somatic morbidity, to marital status, personal worries, type-A behaviour, experience of a hectic or psychologically demanding job, and to consumption of coffee, alcohol, and drugs. Our data lend no support to the concept that peptic ulcer disease is a disorder related to psychologic stress. Causative agents other than smoking should probably be sought among factors characterizing the life style of low socioeconomic classes.

Adolescent↗
PubMed2002

[Functional dyspepsia--a psychosomatic disease].

About 4% of consultations in general practice involve patients with upper gastrointestinal complaints. Evidence of peptic ulcer disease is identified in only 20-30% of the patients. No organic explanation of the symptoms is found using endoscopy in 20-50%; these patients are given the diagnosis non-ulcer dyspepsia or functional dyspepsia. Hypersecretion of gastric acid and the bacteria Helicobacter pylori, which seem to be major aetiologic factors in duodenal ulcer, are not important in functional dyspepsia. In these patients gastric motor abnormalities and visceral hypersensitivity are the most important pathophysiological mechanisms. The gastric motility is influenced by stress; there is a strong relationship between anxiety, depression and functional dyspepsia. Antacids, H2-blockers and prokinetics are hardly more effective than placebo in patients with functional dyspepsia, while antidepressants have been proven effective in reducing dyspeptic symptoms. Likewise, psychological treatment like bio-feedback, stress management, interpersonal psychotherapy and cognitive therapy has also been proven effective in reducing dyspeptic symptoms in patients with functional dyspepsia.

Antacids↗