Stomach ulcer and stress

Stomach Cancer vs. Stomach Ulcers – Differences in Symptoms and Signs

What Causes Stomach Cancer vs. Stomach Ulcers?

Stomach Cancer Causes and Risk Factors

Stomach cancer remains the second most frequent cause of cancer-related death worldwide, with particularly high frequencies in Japan, China, Korea, parts of Eastern Europe, and Latin America. Established risk factors for stomach cancer include:

  • Low socioeconomic status
  • Male sex
  • Cigarette smoking
  • Advanced age
  • A prior diagnosis of pernicious anemia (a chronic progressive disease caused by the failure of the body to absorb vitamin B-12)
  • A diet deficient in fresh fruits and vegetables and rich in salted or smoked fish or meats and poorly preserved foods
  • Treating benign stomach or duodenal ulcer disease by removing part of your stomach is associated with an increased risk of cancer developing in the remaining stomach, especially at least 15 years after the surgery.
  • Recent studies have demonstrated a higher frequency of stomach cancer in people chronically infected with Helicobacter pylori, a common cause of chronic gastritis and peptic ulcer disease.
  • A family history of stomach cancer is a further risk factor in the disease.
  • People with blood type A also have an increased risk.

Stomach Ulcer Causes

When you eat, your stomach produces hydrochloric acid and an enzyme called pepsin to digest the food. The food is partially digested in the stomach and then moves on to the duodenum to continue the process. Peptic ulcers occur when the acid and enzyme overcome the defense mechanisms of the gastrointestinal tract and erode the mucosal wall. In the past it was thought that ulcers were caused by lifestyle factors such as eating habits, cigarette smoking, and stress. Now it is understood that people with ulcers have an imbalance between acid and pepsin coupled with the digestive tract’s inability to protect itself from these harsh substances.

Research done in the 1980s showed that some ulcers are caused by infection with a bacterium named Helicobacter pylori, usually called H pylori. Not everyone who gets an ulcer is infected with H pylori. Aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs) can cause ulcers if taken regularly.

Some types of medical therapy can contribute to ulcer formation. The following factors can weaken the protective mucosal barrier of the stomach increasing the chances of getting an ulcer and slow the healing of existing ulcers.

  • Aspirin, nonsteroidal anti-inflammatory drugs (such as ibuprofen and naproxen), and newer anti-inflammatory medications (such as celecoxib )
  • Alcohol
  • Stress: physical (severe injuries or burns, major surgery)
  • Caffeine
  • Cigarette smoking
  • Radiation therapy:-used for diseases such as cancer
  • People who take aspirin or other anti-inflammatory medications are at an increased risk even if they do not have H pylori infection.
  • Elderly people with conditions such as arthritis are especially vulnerable.
  • People who have had prior ulcers or intestinal bleeding are at a higher-than-normal risk.

If a person takes these medications regularly, alternatives should be discussed with a health-care professional. This is especially true if the affected individual has an upset stomach or heartburn after taking these medications.

Stomach Ulcers Spread by Feces

H pylori bacteria is spread through the stools (feces) of an infected person. The stool contaminates food or water (usually through poor personal hygiene).
The bacteria in the stool make their way into the digestive tracts of people who consume this food or water. This is called fecal-oral transmission and is a common way for infections to spread. The bacteria are found in the stomach, where they are able to penetrate and damage the lining of the stomach and duodenum. Many people who are exposed to the bacteria never develop ulcers. People who are newly infected usually develop symptoms within a few weeks.

Researchers are trying to discover what is different about the people who develop ulcers.

  • Infection with H pylori occurs in all ages, races, and socioeconomic classes.
  • It is more common in older adults, although it is thought that many people are infected in childhood and carry the bacteria throughout their lifetimes.
  • It is also more common in lower socioeconomic classes because these households tend to have more people living together, sharing bathrooms and kitchen facilities.
  • African Americans and Hispanic Americans are more likely to have the bacteria than Caucasians and Asian Americans.

It is important to distinguish between ulcers caused by H pylori and those caused by medications because the treatment is completely different.
Ulcers can be linked with other medical conditions.

People who worry excessively are usually thought to have a condition called generalized anxiety disorder. This disorder has been linked with peptic ulcers.

A rare condition called Zollinger-Ellison syndrome causes peptic ulcers as well as tumors in the pancreas and duodenum.

Stress-Induced Gastritis

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What Are Peptic Ulcers?

There is no clear evidence to suggest that the stress of modern life or a steady diet of fast food causes ulcers in the stomach and small intestine, but they are nonetheless common in our society: About one out of every 10 Americans will suffer from the burning, gnawing abdominal pain of a peptic (or gastric) ulcer at some point in life.

Video Transcript

American College of Gastroenterology: “Peptic Ulcer Disease.”; Medical University of South Carolina: “Peptic Ulcers.”; KidsHealth: “Peptic Ulcers.”; Cleveland Clinic: “Peptic Ulcer Disease.”; AudioJungle; ROYALTYSTOCKPHOTO/SCIENCE PHOTO LIBRARY; Olga Miltsova; Antonio_Diaz; Rainer Junker; iStock.

Peptic ulcers are holes or breaks in the protective lining of the duodenum (the upper part of the small intestine) or the stomach — areas that come into contact with stomach acids and enzymes. Duodenal ulcers are more common than stomach ulcers. Comparatively rare are esophageal ulcers, which form in the esophagus — or swallowing tube — and are often a result of exposure to medications, like certain antibiotics or anti-inflammatories, or alcohol abuse.

Until the mid-1980s, the conventional wisdom was that ulcers form as a result of stress, a genetic predisposition to excessive stomach acid secretion, and poor lifestyle habits (including overindulging in rich and fatty foods, alcohol, caffeine, and tobacco). It was believed that such influences contribute to a buildup of stomach acids that erode the protective lining of the stomach, duodenum, or esophagus.

While excessive stomach acid secretion certainly plays a role in the development of ulcers, a relatively recent theory holds that bacterial infection is the primary cause of peptic ulcers. Indeed, research conducted since the mid-1980s has shown that the bacterium Helicobacter pylori(H. pylori) is present in more than 90% of duodenal ulcers and about 80% of stomach ulcers. However, more recent figures indicate those percentages are declining.

Other factors also seem to contribute to ulcer formation. Overuse of over-the-counter painkillers (such as aspirin, ibuprofen, and naproxen), heavy alcohol use, psychological stress, and smoking exacerbate and may promote the development of ulcers, especially in someone with H. pylori.

Other studies show that stomach ulcers are more likely to develop in older people. This may be because arthritis is prevalent in the elderly, and alleviating arthritis pain can mean taking daily doses of aspirin or ibuprofen. Another contributing factor may be that with advancing age the pylorus (the valve between the stomach and duodoneum) relaxes and allows excess bile (a compound produced in the liver to aid in digestion) to seep up into the stomach and erode the stomach lining.

Peptic ulcers, also known as stomach ulcers, are open sores that develop in the lining of the esophagus, stomach or the first part of the small intestine, known as the duodenum. Over 25 million Americans will suffer from an ulcer at some point during their lifetime, according to the Centers for Disease Control and Prevention (CDC), and there are approximately 500,000 to 850,000 new cases of ulcer disease each year.

Most ulcers are caused by an infection by Helicobacter pylori bacteria (H. pylori), and can be treated in about two weeks with antibiotics, according to the CDC.

“The two most common causes of ulcers are H. pylori, a bacterial infection, and medications, most commonly aspirin and other non-steroidal anti-inflammatory medicines (NSAIDs), and iron tablets,” said Dr. Arun Swaminath, director of the Inflammatory Bowel Disease Program at Lenox Hill Hospital in New York City.

The discovery of H. pylori’s role in ulcers led to the Nobel Prize in 2005 for Barry Marshall and Robin Warren, who were ridiculed when they suggested the idea, Swaminath said. It is a myth that peptic ulcers are caused by stress and spicy food. But these factors make someone who already has ulcers feel even worse.

“Psychological stress probably has no role in the development of ulcers, though biological stress like being a very ill patient in the intensive care unit can definitely contribute to ulcers,” Swaminath said. “Foods aren’t really thought to contribute to ulcers, but they may make patients with already present inflammation or ulcers feel worse depending on what’s eaten,” he said.


The most common symptom of peptic ulcers is a burning pain in the stomach, according to the National Institutes of Health (NIH). Typically, the pain starts between meals or during the night, and may stop if you eat or take antacid medications. The pain comes and goes for several days or weeks, and can be felt anywhere from your navel up to your breastbone, according to Mayo Clinic.

Although the most common symptom of ulcers is pain, the condition can also present as bleeding or anemia, Swaminath said. “There are a lot of other organs around the area of the stomach. Part of the challenge of figuring out what is causing the ‘abdominal pain’ is to rule in or out things like: pancreatitis, gallstones, Crohn’s disease, or stomach cancer.”

Psychological stress can cause symptoms that mimic the symptoms of ulcers, Swaminath said. But because stressed-out people are at the same risk for factors that really can result in ulcers, they should consult their doctor if they have persistent symptoms, he said.


Peptic ulcers happen when the acids that help digest food damage the walls of the stomach or duodenum. The insides of the digestive tract are coated with a mucus layer that protects against stomach acid, but in some people who are infected with H. pylori, the bacteria get into the mucosal lining in the stomach, creating holes and exposing more sensitive tissue to stomach acid.

H. pylori is a common infection, and it is possible that the bacteria is spread between people through contact with infected stool, vomit or saliva. It also may be contracted from contaminated water or food. According to the Mayo Clinic, one in five young adults is actually infected with the bacteria. Still, for unknown reasons it does not result in ulcers in everyone.

Another cause is the regular use of certain pain relievers, specifically, non-steroidal anti-inflammatory drugs (NSAIDS) such as aspirin and ibuprofen (Advil). The CDC states that 10 percent of ulcers are caused by NSAIDs. These medications, as well as naproxen (Aleve) and ketoprofen, can irritate or inflame the lining of the stomach and small intestine. Peptic ulcers are more common in older adults who take these pain medications frequently or in people who take these medications for osteoarthritis.

Cigarettes, alcohol, and stress can exacerbate symptoms by further irritating the stomach lining.

If left untreated, stomach ulcers can cause bleeding from the ulcer that can lead to anemia. The bleeding can show up as black colored stool, Swaminath said.

Diagnosis & tests

Doctors most commonly diagnose ulcers using endoscopy, Swaminath said. This involves “taking a camera directly into the stomach to look for ulcers and taking biopsies to make sure the ‘ulcers’ aren’t really cancer or something else,” he said.

There are several other tests for the diagnosis of stomach ulcers. A physician may use a blood, stool, or breath test to detect the presence of H. pylori or antibodies to H. pylori, according to the Mayo Clinic.

A breath test consists of drinking a glass of liquid that contains a radioactive substance. This substance reacts with H. pylori so that when an individual with stomach ulcers blows into a bag, the breath will contain the radioactive carbon in the form of carbon dioxide.

Sometimes an X-ray exam may be performed to visualize the ulcer. A liquid containing a metal element called barium is ingested for this procedure. If an ulcer is found, the physician may look inside the digestive tract with endoscope, a flexible tube with a camera and light attached.

Treatment & Medication

Treatment of stomach ulcers consists of killing H. pylori and decreasing the amount of acid in the stomach. This requires several types of medications.

Physicians may prescribe several antibiotics at once, or use a combination drug such as Helidac to kill H. pylori. Helidac contains two antibiotics along with an acid-reducing drug and a medication that protects stomach tissue.

The doctors will also try to stop other medications the patient is taking and might have a role in worsening the ulcers.

“Most of the time, we try to withdraw the offending medication, but that is not always possible, for example patients on aspirin who have heart arrhythmias, or recent heart stents,” Swaminath said.

“We put patients on high doses of the drug for eight weeks by which time the area will typically heal,” Swaminath said. “A low dose is continued indefinitely if the offending medication can’t be discontinued.”

Drugs called acid blockers (for example, Pepcid) and antacids may be recommended to decrease the levels of stomach acid. Other medicines, called proton pump inhibitors, such as Prilosec and Prevacid, are another option. They work by blocking cellular pumps that release acid into the stomach.

Additional reporting by Alina Bradford, Live Science contributor.

Additional resources

  • Helicobacter pylori: A Nobel pursuit?
  • U.S. Department of Health and Human Services: Symptoms & Causes of Peptic Ulcers (Stomach Ulcers)
  • National Health Services: Stomach Ulcer
  • Women’s Health: Do I Have an Ulcer?


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“If you guys don’t stop yelling, you’ll give me an ulcer!”

“There’s been so much stress at work lately, I’m sure I’ll get an ulcer.”

“Don’t worry so much. Do you want an ulcer?”

When people talk like this, it sounds like ulcers are easy to give and easy to get. It also sounds like stress is to blame. But is that the real story?

What Is an Ulcer?

An ulcer is a sore, which means it’s an open, painful wound. Peptic ulcers are ulcers that form in the stomach or the upper part of the small intestine, called the duodenum (pronounced: doo-uh-DEE-num).Peptic ulcers are actually very common.

What Causes an Ulcer?

For almost 100 years, doctors believed that stress, spicy foods, and alcohol caused most ulcers. Now we know that most peptic ulcers are caused by a particular bacterial infection in the stomach and upper intestine, by certain medications, or by smoking.

In 1982, two doctors — Barry Marshall and Robin Warren — discovered a certain kind of bacteria that can live and grow in the stomach. Both doctors went on to win the Nobel Prize for their discovery. The medical name for these bacteria is Helicobacter pylori (or H. pylori, for short). Today doctors know that most peptic ulcers are caused by an infection from H. pylori.

Experts believe that 90% of all people with ulcers are infected with H. pylori. But strangely enough, most people infected with H. pylori don’t develop an ulcer. Doctors aren’t completely sure why, but think it may partly depend upon the individual person — for example, those who develop ulcers may already have a problem with the lining of their stomachs.

It’s also thought that some people may naturally secrete more stomach acid than others — and it doesn’t matter what stresses they’re exposed to or what foods they eat. Peptic ulcers may have something to do with the combination of H. pylori infection and the level of acid in the stomach.

How Ulcers Form

When H. pylori bacteria do cause ulcers, here’s how doctors think it happens:

  1. Bacteria weaken the protective coating of the stomach and upper small intestine.
  2. Acid in the stomach then gets through to the sensitive tissues lining the digestive system underneath.
  3. Acid and bacteria directly irritate this lining resulting in sores, or ulcers.

Although H. pylori are responsible for most cases of peptic ulcers, these ulcers can happen for other reasons, too. Some people regularly take pain relievers known as nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin or ibuprofen, that fight inflammation in the body and are used to treat long-term painful conditions like arthritis. If taken in high daily doses over a long period of time, NSAIDs can cause ulcers in some people.

Smoking also is associated with peptic ulcers. Smoking increases someone’s risk of getting an ulcer because the nicotine in cigarettes causes the stomach to produce more acid. Drinking a lot of alcohol each day for a period of time can also increase a person’s risk of ulcers because over time alcohol can wear down the lining of the stomach and intestines.

In certain circumstances stress can help cause ulcers. But this usually only happens when illness involving severe emotional or physical stress is involved — such as when someone too sick to eat for a long period of time.

Ulcers occur because of uncontrolled increased acid production in the stomach and changes in the immune system (the body system that fights infection). With any illness where the body’s ability to heal is challenged (such as when someone has serious burns from a fire), there is a risk for developing ulcers.

Signs and Symptoms

Stomach pain is the most common symptom of an ulcer. It usually feels like sharp aches between the breastbone and the belly button. This pain often comes a few hours after eating. It can also happen during the night or early in the morning, when the stomach is empty. Eating something or taking an antacid medication sometimes makes the pain go away for awhile.

Other symptoms of ulcers can include:

  • loss of appetite
  • sudden, sharp stomach pains
  • nausea
  • frequent burping or hiccuping
  • weight loss
  • vomiting (if blood is in the vomit or the vomit looks like coffee grounds, which only happens with severe ulcers, call a doctor right away)
  • bloody or blackish bowel movements (this could indicate a serious problem, so call a doctor right away if you see this)

Anyone who thinks he or she may have an ulcer needs to see a doctor. Over time, untreated ulcers grow larger and deeper and can lead to other problems, such as bleeding in the digestive system or a hole in the wall of the stomach or duodenum, which can make someone very sick.

How Are Ulcers Diagnosed?

In addition to doing a physical examination, the doctor will take a medical history by asking about any concerns and symptoms you have, your past health, your family’s health, any medications you’re taking, any allergies you may have, and other issues. If you have stomach pain or other symptoms of an ulcer, the doctor will perform some tests to help make the diagnosis.

One test is called an upper gastrointestinal (GI) series. This is a type of X-ray of the stomach, duodenum, and esophagus, the muscular tube that links the mouth to the stomach. A person drinks a whitish liquid called barium while getting an X-ray, and if he or she has an ulcer, it should be outlined on the X-ray.

Another common procedure to look for an ulcer is called an endoscopy (pronounced: en-DOSS-kuh-pee). During this test, the doctor uses an endoscope, a skinny, lighted tube with a special camera on the end.

A person getting an endoscopy is given anesthesia and will have no memory of the procedure. For an endoscopy, the doctor gently guides the endoscope into the throat and down into the esophagus, and finally into the stomach and upper intestines. The doctor is able to look at the inner lining of these organs from the camera on a television screen and can even take pictures. Tissue can be removed during an endoscopy and then tested for H. pylori bacteria.

A doctor can also do a blood test for H. pylori bacteria. This may be important if an ulcer is found in the upper GI series. The blood test can be done right in the doctor’s office. Sometimes a bowel movement or a person’s breath can also be specially tested to check for the H. pylori bacteria.

How Are Ulcers Treated?

Ulcers caused by H. pylori bacteria are generally treated with a combination of medications:

  • Usually two antibiotics to kill the H. pylori bacteria are taken every day for about 2 weeks.
  • Antacids — acid blockers or proton pump inhibitors — are given for 2 months or longer to lessen the amount of acid in the stomach and help protect the lining of the stomach so the ulcer can heal.

Ulcer Prevention

Doctors are not totally certain how H. pylori bacteria are transmitted from person to person. The bacteria have been found in saliva, so kissing may be one way. They also may be spread through food, water, or contact with vomit (puke) that has been infected with the bacteria.

The best advice in ulcer prevention is to always wash your hands after you use the bathroom and before you eat and to take good care of your body by exercising regularly and not smoking or drinking.

Reviewed by: J. Fernando del Rosario, MD Date reviewed: July 2015

Managing Stress When You Have an Ulcer

As with most illnesses, stress can exacerbate your symptoms when you have an ulcer. Ulcers are sores on the lining of the stomach or duodenum, the first part of the small intestine. Ulcers can be very painful and can lead to emergency situations if they are not treated.

Ulcer: The Stress Connection

Two-thirds of all ulcers are believed to be caused by exposure to a bacterium known as Helicobacter pylori (H. pylori). Stress is thought to worsen ulcers by increasing the production of acid in the digestive tract. H. pylori break down the protective lining of the stomach and duodenum, making the delicate tissue even more vulnerable to the effects of the acid.

Additionally, ulcers that develop in people who do not have an H. pylori infection may be aggravated by stress as well.

Ulcer: Dealing With Stress

It’s not surprising, then, that many doctors recommend stress reduction techniques to their ulcer patients. “Stress reduction does help in the management of many gastroenterological disorders, such as irritable bowel syndrome and inflammatory bowel disease,” says Michael Brown, MD, a gastroenterologist and associate professor of medicine at Rush University Medical Center in Chicago. “I wouldn’t be surprised if it helped with peptic ulcer disease also.”

Ulcer: Stress Management Tips

If you already have an ulcer, Dr. Brown cautions that stress reduction may not help it heal any faster, but it could help you feel better and may reduce your risk of developing future ulcers.

To offset stress, you may want to consider the following:

  • Changing how you react. You may not be able to change the things that cause you stress, but you can change your reaction to them. People with negative attitudes often report more stress than people with a more positive outlook. Try to think about positive things in your life when negative thoughts arise.
  • Maintaining your physical health. Eat well, get plenty of sleep, and exercise regularly. Poor health can weaken your immune system, leaving you vulnerable to infections, including H. pylori, and can make you feel irritable and even more stressed.
  • Staying physically active. Try to exercise for at least 20 minutes, three days a week. Along with its well-known physical health benefits, exercise can reduce symptoms of anxiety and depression.
  • Compromising. Taking a rigid stand on every issue can lead to unnecessary arguments and added stress. Learn to give in once in a while, or try to reach compromises with others.
  • Setting limits. Don’t take on so many tasks and responsibilities that you start feeling angry and resentful. Remember to make time for yourself and activities that are important to you.
  • Reaching out to others. Isolation intensifies stressful feelings. Spending time with friends can help shift the focus off your problems, at least for a short while. If you’re really having a difficult time, consider professional therapy or counseling.
  • Building some relaxation time into your day. No matter how frantic your life may be, you can always find 10 to 20 minutes to take a walk, read a book, listen to music, or engage in some other activity that helps you slow down and keep things in perspective.

Ulcer: Stress Reduction Techniques

Many people relax through specific stress reduction techniques, such as:

  • Deep breathing. Breathe in slowly through your nose, hold for three seconds, then exhale through your mouth. This is a quick stress-reducer that can be done any time.
  • Body awareness. Sit in a quiet room with your arms and legs uncrossed, and simply concentrate on making your body as still as possible. This may require some practice.
  • Progressive muscle relaxation. Starting with your facial muscles and working down through your neck, shoulders, arms, and legs, squeeze each muscle group for three to five seconds, then relax. Don’t forget your abdominal muscles and your buttocks.
  • Hand clench. If you don’t have time for complete muscle relaxation, concentrate on your hands: Clench each one into a fist, hold for five seconds, and then release slowly, focusing on the movement as you relax your muscles. Do each hand separately.
  • Guided imagery. Think of this as a vacation inside your head: Imagine yourself in a relaxing spot, whether it’s on a beach, in the woods, or the mountains — anywhere that relaxes you. Spend some time there; notice details such as trees, flowers, sunlight, and sounds like a waterfall or birds chirping.

Actively reducing the effects of stress in your life can help reduce ulcer symptoms and is also essential to protecting your overall health.

Does Stress Cause Ulcers? Round II

This question has been posed for decades and although psychologcial stress was long believed to be a potential cause of peptic ulcer disease, the theory has been largely displaced by the discovery of the role of Helicobacter pylori in ulcer formation and with the known association between nonsteroidal anti-inflammatory drugs and gastric erosion. Several authorities on this topic actually concluded that “ulcers are not caused by stress.”1 The findings from a recent study by Levenstein and colleagues argue otherwise.2

The cohort examined included a random sample of more than 3000 Danish adults who were participating in a World Health Organization study of cardiovascular diseases. All subjects who had ulcers or a positive H pylori serology at baseline were excluded from the study. Participants were interviewed and completed a 12-item questionnaire regarding their stress levels at baseline, at 5 years, and at 10 years. Questions asked for information on employment status, number of hours worked per week, sleep duration per night, alcohol and tobacco consumption, use of tranquilizers, leisure time, and exercise habits. A score from 0 to 10 points was assigned to each survey.

At the end of the study, 76 participants had developed ulcers confirmed via endoscopy, barium study, or surgery. Among the subjects who developed an ulcer, stress level was higher based on the results of the survey. Specifically, those who scored in the highest tertile of stress scores had more than double the risk of developing gastric or duodenal ulcers than those in the lowest tertile (3.5% vs 1.6%, respectivley). For every one point increase in the survey stress score, the risk of ulcer increased by 12%. After adjusting for NSAID use and H pylori status, stress remained a significant predictor of peptic ulcer disease. Socioeconomic status and smoking were also independent predictors. Stress increased risk for both gastric ulcers (OR = 1.19; 95% CI, 1.03-1.37) and duodenal ulcers (OR = 1.11; 95% CI, 0.98-1.27).

“. . . those who scored in the highest tertile of stress scores had more than double the risk of developing gastric or duodenal ulcers.”

Despite examining a historical cohort and using an unvalidated questionnaire for stress, this study has several strengths. It had sufficient power to control for known causes of peptic ulcer disease, namely NSAID use and H pylori status. The authors confirmed all causes of ulcers and did not rely on patient self-report. Importantly, the researchers were able to follow the same cohort longitudinally for more than a decade, and all participants answered the same questions at 3 different time points. The results reintroduce the question of what role stress may play in the etiology of peptic ulcer disease. Further studies are needed to validate these findings.

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