Surveying the association between life stresses and gastrointestinal diseases [peptic ulcer]

The Association between physical and psychological disorders has been demonstrated repeatedly. Gastro intestinal disorders are common medical diseases which have similar symptoms with mental disorders and also may produce psychiatric problems or be aggravated under psychological distress. Gastro intestinal complaints are among the most common symptoms in primary care and internal clinics that frequently remained unexplained. Most of prior studies are dealing with mental changes following the digestive disease. The present study has evaluated mental changes during the prior year of digestive disease diagnosi in a group of patients with definite peptic ulcer. 200 peptic ulcer cases [140 males and 60 females] who had referred during 1376.10.20 and 1377.10.20 and indicated for endoscopy were randomly selected. We completed Holmes-Rahe mental-social table and a questionnaire dealing with risk factors of digestive diseases such as cigarette smoking, NSAIDs, alcohol, and caffeine use and also O blood group. Patients were assigned in two groups of A [disease onset prior to 6 months ago] and B [disease onset during the past 6 months]. The mean stress of male patients in group A and B was 253 and 218, respectively. These figures were 257 and 221 in females. Of 140 males, 104 [74.2%] had blood group O, 17.2% were smoker and 8.6% had the history of NSAIDs use. The corresponding figures were 46.6%, 26.6% and 26.7% in females. Among 200 patients, endoscopy failed to show evidences of cancer or helicobacter pylori infection in 120. These patients were discharged by antacid, H[2] blocker and mild tranquilizer therapy. The remaining 80 cases had positive pathologic findings favourable of helicobacter infection with gastric esophageal, or pancereas malignancies.Results have revealed that 60% of the studied patients had just one stress tension during their life. Thus, mental changes are prior to physical changes. Physicians should concern more about the mental-social changes in patients liable to digestive system diseases. Stress should always be kept in mind in the management of the affected patients

Estudo de caso: úlcera péptica em adolescentes / Case study: peptic ulcer in adolescents

A úlcera péptica é uma das doenças psicossomáticas que mais tem suscitado o aparecimento de várias pesquisas que procuram evidenciar a influência de fatores psicossociais. Na tentativa de contribuir para a compreensão dos seus dinamismos psíquicos, o presente estudo analisou o caso de uma adolescente, segundo o referencial psicanalítico.

Estrés psicosocial y úlcera péptica duodenal: una perspectiva bio-psico-social / Psychosocial stress and duodenal peptic ulcer: A bio-psycho-social perspective

El presente artículo plantea un modelo en el que se describe el proceso a través del cual el estrés psicosocia] puede inducir el desarrollo de la úlcera péptica duodenal (UPD) y los sistemas psicológicos, biológicos y sociales que se ponen alli en juego. Primero se analiza el papel de los sucesos vitales estresantes y del estrés percibido. Posteriormente se revisa cómo las estrategias de afrontamiento y la atribución causal del propio sujeto contribuyen a la UPD. Mas tarde se analiza cómo el estrés podría permitir que la bacteria H. Pylori se convierta en un agente patógeno, produciendo una actividad del ácido péptico y disminuyendo las defensas de la mucosa. Finalmente el artículo termina planteando relaciones entre UPD y nivel socio-económico.

Estudo psicossocial de portadores de úlcera péptica na erradicaçäo do Helicobacter pylori / Psychosocial study of individuals suffering from peptic ulcers in the erradication of the Helicobacter pylory

O trabalho objetiva a caracterizaçäo psicossocial de indivíduos portadores de úlcera péptica, na erradicaçäo do Helicobacter pylori. Säo expostos aspectos históricos psicossociais das doenças e tecidas considerações sobre o conhecimento atual acerca da úlcera péptica e do H. pylory. A revisäo da literatura enfatiza a forte tendência de associar fatores psicossociais ao desenvolvimento da úlcera péptica. Foram estudados 18 indivíduos através de entrevistas e questionário, com diagnóstico endoscópico positivo de úlcera péptica e infectados pelo H. pylori, antes e depois do tratamento para erradicaçäo da bactéria. As entrevistas foram gravadas e analisadas através da análise do discurso, com referencial psicanalítico e os questionários analisados descritivamente. O conflito dependência-independência apresentou-se de maneira peculiar, sendo a dependência a característica manifesta, sugerindo-se como explicaçäo as precárias condiçöes sócio-econômicas do grupo estudado. Observou-se que o tratamento para erradicaçäo do H. pylori trouxe significativa melhora da qualidade de vida para os pacientes.

Peptic ulcer disease and Jamaican patients' awareness of their disorders

In the management and prevention of recurrence of peptic ulcer disease, patients' awareness of their disorder is essential. Fifty-one patients with peptic ulcer disease were studied regarding their awareness of their disorder and compliance with medications. There were 30 women and 21 men with a mean age of 45 years. Thirty-five per cent had secondary school education; 22 per cent had tertiary training and 10 per cent had no formal education. Sixty-three per cent of patients knew their ulcer location but 37 per cent were unaware of their diagnosis. Twenty-nine per cent received most of their information from their pharmacists. Twenty per cent of patients smoked cigarettes; 31 per cent drank alcohol, and 14 per cent took non-steroidal analgesics. Seventy-six per cent thought that poor eating habits were a contributory cause of their ulcer, 39 per cent thought that stress was a cause and 16 per cent implicated heredity. Seventy-six per cent of patients took their medications daily, and 24 per cent only when symptomatic. Jamaican patients' awareness of their ulcer disease is inadequate. There is a need for more physician education of their patients as well as public health promotion about peptic ulcer disease.

Neuroticism and stressful life events in patients with non-ulcer dyspepsia.

Hindi adaptation of the Middlesex Hospital Questionnaire (MHQ), Brief Psychiatric Rating Scale and Presumptive Stressful Life Events Scale were used to measure neuroticism, psychiatric morbidity and stressful life events in 35 patients with non-ulcer dyspepsia (NUD), 22 cass of peptic ulcer disease (PUD), 65 irritable bowel syndrome (IBS) and 45 age and sex matched healthy controls. NUD subjects had significantly higher total MHQ scores (28.8 +/- 11.3; p < 0.001) and scores in subscales of somatization (7.8 +/- 3.4; p < 0.001) and hysterical personality traits (5.5 +/- 2.8; p < 0.01) compared to healthy controls. MHQ scores in IBS subjects was significantly higher than in NUD, but in PUD subjects it was in-between NUD and healthy controls. Psychiatric morbidity, as assessed by Brief Psychiatric Rating Scale, was significantly higher in patients with NUD and IBS than in normal controls. Stressful Life event score was statistically similar in all the groups.

El enfermo con úlcera gastroduodenal (UGD): algunos factores psicosociales de interés y enfoque psicoterapéutico en el enfermo con úlcera gastroduodenal / The patients with gastroduodenal ulcer (GDU): some interesting psychosocial factors and the psychotherapeutic approach to this patient

Se analiza la importancia de los factores psicosociales en la etiopatogénesis de la úlcera gastroduodenal (UGD), destacándose los aspectos más sobresalientes que al respecto se señalan por diferentes autores. Más adelante se abordan las características psicosociales de los pacientes ulcerosos descritas en la literatura, así como los aspectos más sobresalientes presentes en el enfoque psicoterapéutico ante los enfermos que presentan los llamados disturbios psicosomáticos. Finalmente se hace la valoración del papel que juega la relación medicopaciente (RMP) en el tratamiento de los pacientes ulcerosos

Ulcera péptica y sintomatologia psiquiátrica: un estudio descriptivo / Peptic ulcer and psychiatric symptomatology: a descriptive study

Este trabajo describe clínica y biográficamente tres casos típicos de pacientes ulcerosos pépticos, provenientes de una muestra secuencial de 40 casos estudiados desde el punto de vista psicosocial por los autores. Estos 40 casos provienen de los diagnósticoss endoscópicos realizados en el Departamento de Gastroenterología del Hospital del Salvador. Llama la atención la prevalencia de sintomatología ansiosa, que predomine entre los ulcerosos, duodenales, mientras que entre los gástricos las estructuras depresivas son más frecuentes. Los problemas familiares (alcoholismo paterno, muerte o abandono por parte de los hijos) representan eventos generadores de stress especialmente frecuentes en estos pacientes