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Does Stress Cause Ulcers?

While laying down the definition of stress. We looked at the experiments conducted by Selye who discovered the diseases of stress response when he found his laboratory rats developing ulcers. In common parlance, we use the term 'to get ulcers' as a way to indicate a stressful situation. In this article, we will take a closer look at the link between chronic stress, ulcers and some other diseases of the digestive system.

Stress Response

We will now take a look at the digestive system's response to stress. In the face of an acute physical stressor, it makes sense for the body to turn off all activities that consume a lot of energy and do not provide any immediate benefits. Digestion may be good in the long term by providing essential nutrients but it is useless in dealing with the immediate emergencies. The first step in the process is to stop the production of saliva as a result of which the mouth becomes dry. The stomach grinds to a halt; enzyme and acid secretion and contractions are stopped. The small intestine stops its movement and absorption does not take place. The blood flow to the digestive system is reduced and the blood delivers the oxygen and glucose to the exercising muscles where it is required. It all shows a superbly adapted system responding.

Before we look at how repeated stressors can cause problems in the digestive system, it will help to know about one more process involved in digestion. Earlier, we saw how the muscular movement broke down food mechanically. The body uses another trick to break down food-the use of hydrochloric acid. This is a powerful acid and it breaks down virtually anything we eat-meats, vegetables, fat, refined foods, etc. The contractions help but the main weapon in the degradation is the hydrochloric acid. Even before this explanation is over, the alert reader would have noted some­thing amiss. How come the acid does not degrade our own stomach? The answer is that the stomach has built layers and layers of protective mucous. The stomach has to expend a huge amount of effort to make sure that the acid does not affect its walls. This seems like a wonderful solution and digestion can proceed. Just to give an idea of the high level of protection, we see that there are at least six layers that protect the stomach from the acid.

Back to our original point on how stress causes problems with the digestive system. During a prolonged period of stress, digestion is frequently inhibited. To conserve energy, the stomach starts to economize and slows down the process of building the mucous walls. At the end of the stressor, when digestion resumes, the acid attacks the stomach walls-ulcer. An interesting point to note here is that the actual damage does not occur during the stressor but in the phase of recovering from the stressor. The obvious non-workable solution to avoid ulcers is to continue in the stressed condition. A more practical conclusion is that several periods of transient stress are worse than one prolonged period of stress from the point of view of ulcer formation.

Most experts agree that massive stressors like trauma, infections, accidents or burns can lead to the formation of stress ulcers just as described above. The difficulty is in explaining the ulcers that form over a period of time (emerging ulcers). There is an interesting story behind the discovery of the causes of emerging ulcers.

Do Bacteria Cause Ulcers?

In 1983, an Australian pathologist named Robert Warren discovered a bacterium called helicobacter pylori. He enlisted the help of his colleague Barry Marshall, who stated that this bacterium turned up consistently in the stomachs of people suffering from duodenal ulcers and stomach inflammation. He took a daring step and theorized that the bacterium actually caused the inflammation and the ulcer. He announced his findings at an international conference on gastroenterology and was promptly laughed out of the hall. Everyone knew that diet, stress, and genetic predisposition caused ulcers not some unknown bacterium. To further discredit his theory critics pointed out that the stomach is so acidic that no bacterium can survive there. Marshall countered by proving that helicobacter pylori did cause ulcers in laboratory mice. His experiments were promptly dismissed as being inapplicable to human conditions! In a heroic gesture worthy of any second rung Hindi movie, the mad scientist swallowed some bacteria and developed gastritis. Other researchers decided to conduct additional studies and they found that he was absolutely right. It turns out that helicobacter pylori do live in the acidic stomach. It protects itself with a coating that is acid resistant and further wraps itself in a coat of bicarbonate. This bacterium probably explains over 80 per cent of the cases of ulcers in western populations.

In the developing world nearly 100 per cent of the people are infected by this bacterium but not all suffer from ulcers. It is probably the most chronic bacterial infection in humans. The bacterium infects cells lining the stomach wall and cause gastritis. This compromises the ability of the cells to defend against the stomach acid-and you end up with an ulcer in the duodenal wall. Many details are being sorted out but the greatest triumph for the two Australians has been the near universal adoption of their theory. It has now become common to treat ulcers with antibiotics like amoxycillin. Best of all, various studies have shown that ulcers can be cured and the infection does not recur.

Now for the interesting postscript. Only 10 per cent of the people infected with the bacteria get an ulcer. It means that there is some other agent in addition to the bacterium that causes ulcers. The consensus seems to be that stress by itself does not cause ulcers. Rather, stress worsens the impact of helicobacter pylori infection and that leads to ulcers. Repeated studies have shown that in humans, ulceration is likely to occur in people who are anxious, depressed, or undergoing severe life stressors. Some very sophisticated studies coupled with equally complicated statistical analysis have shown that in the case of massive infections with helicobacter pylori, even moderate stressors can cause ulcers. In the case of massive stressors, even a minor infection is enough to cause ulcers.



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