1. STRESS AND DISEASE - Ia Peptic Ulcers:For years there was an established relationship between peptic ulcers (and other GI irritative diseases) and psychological stress.Marshall and Warren “Unidentified curved bacilli in the stomach of pts with gastric and peptic ulceration” (Lancet, 1984)Very tight causal relation between Helicobacter pylori and peptic ulcer and other irritative GI diseases.Diagnosis of infection (serology, IGG for H.p.; or endoscopy-biopsy), treat with antibiotics (tetracycline, metronidazole), is eradicating H. pylori infection in much of US population So What Happened to the Relationship to Stress?

2. STRESS AND DISEASE - Ib Evidence for a Relationship Between Stress and Ulcers:Gastric fluids increase acidity in response to anger, hostility, resentment, guilt, frustration.Stressful situations (surgery, school exams) increase basal gastric acid secretion.Alleviation of stress can reverse peptic ulcer condition.Animals exposed to stress develop stomach ulcers.Ulcer occurs in the absence of H. pylori infection.Most people still have H. pylori infection and do not have ulcers.Ulcer patients more likely to exhibit excess stress (Levenstein & Veylan, J. Clin. Gastroenterol., 1995).Psychological stress impedes ulcer healing.Other factors also important: sex (choose female), blood type (avoid O), other genetics, cigarettes, coffee, alcohol consumption patterns, possibly diet. These are not correlated with presence or degree of H. pylori infection.A “Psychosomatic” etiology is often preferentially discarded as soon as a “biological” explanation becomes available.

3. STRESS AND DISEASE - Ic Aside from Impaired Treatment of Pts and Widespread Overprescription of Antibiotics, are there Costs? On the Horizon:Absence of H. pylori infection may be linked to gastroesophogeal reflux disease (“acid reflux”; Labenz et al., Gastroenterology, 1997)Reflux disease increases risk for gastric adenocarcinoma, a serious form of malignancy, which has recently also been linked by co-occurrence to absence of H. pylori infection.H. pylori infection is dropping, especially among SES levels with good medical care.Stay tuned. And don’t throw out good data just because something more “biological” comes along. Consider the whole patient, both in theory and in practice.