LIFE STRESSORS IN DUODENAL ULCER--TWO SUBPOPULATIONS

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Methodological problems in pinpointing external stressors and the predominance of chronic disease in case series have impeded understanding of the relationship between life stress and duodenal ulcer. By appropriate choice of methods and patient population, this study aims to elucidate permissive and mediating factors in the psychosomatic process, and to define the natural history of stress-induced ulcer. It is hypothesized that life stress causes a distinct subgroup of ulcers, that this process is allowed by gastric hypersecretion and a certain personality structure and is mediated partially through anxiety-related abuse of alcohol, cigarettes, and coffee, and that ulcers arising from temporary stress may heal slowly but will have a good long-term prognosis. A pilot study has given support to several of these distinctive features of stress ulcers. The design calls for administration of a standardized interview instrument, validated in italy, to italian patients with endoscopically documented, recent-onset ulcer who do not have chronic symptoms and are not on maintenance therapy, in order to identify a subpopulation whose disease was preceded by distressing life experiences. The demographic and physiologic characteristics, use of ulcerogenic substances, mood and personality of this subgroup will then be compared with those of the rest of the ulcer population. Repeat endoscopy at six weeks will detect differences in short-term prognosis between the two groups, while periodic telephone interviews will permit comparison of their long-term course.