There connection between stress and stomach problems is well known. We have all experienced it at some time or the other. It can vary from a little indigestion, to a dull ache or even chronic stomach problems when we are stressed.  However, there is sometimes confusion about whether stress causes these stomach problems or not. In fact, there is even more confusion about what stress means in the context of related esophagus (gullet), stomach and intestinal problems. With regards to gastritis, the term stress gastritis is probably the most misunderstood type of stomach problem by the average person. Are we talking about stresses in life that is associated with financial worry and relationship disruptions? Or are we talking about the strain on the body as a result of major illness?

What stress causes stomach problems?

Stress in life can worsen gastritis, flare up stomach ulcers and exacerbate related stomach problems. It does not cause these stomach problems. However, stress with illness can cause stomach problems like gastritis and ulcers. It is therefore important to differentiate between these types of stress.

Stress in Life

The term stress is often used loosely to refer to any period of inconvenience, tension and discomfort in our lives. In these instances we are referring to mental or emotional stress which may be brought about by worry, anxiety, grief and anxiety. The collective term for these mental and emotional strains is psychological stress. In other cases it may be due to continuous and strenuous physical activity and refers to physical stress, although many of us prefer to use the word strain.

It is, however, important to consider lifestyle changes with psychological stress and physical strain. Overuse of medication and excessive alcohol consumption, heavy cigarette smoking and irregular meal times are events that arise when we are stress. It is this behavior that can possibly cause gastritis and ulcers, but not the psychological stress or physical strain itself.

Stress with Illness

However, there is another form of stress that impacts on the body. This is stress that accompanies severe and debilitating conditions where the patient is in a period of critical care. It may be seen with :

  • Debilitating illness
  • Extensive burns
  • Major surgery
  • Severe trauma
  • Mechanical ventilation
  • Multi-organ failure

Often these types of stresses accompanies hospitalization and without proper management death is possible. Stress with debilitating illness causes stress gastritis, more correctly known as stress-induced gastritis, and stress ulcer syndrome.

How does stress causes gastritis and ulcers?

A Healthy Stomach Prevents Gastritis and Ulcers

A healthy stomach has a mucus barrier that prevents the stomach acid within it from making contact with the stomach wall tissue. Thousands of mucus cells and glands in the stomach wall are constantly producing mucus to protect the inner lining of the stomach wall. In gastritis, stomach ulcers and related problems, it is this mucus barrier that is somehow compromised. The causative factor may injure and inflame the stomach wall to some extent. However, it is the stomach acid that causes more severe damage of the stomach wall.  Sometimes the mucus barrier may be normal but the stomach acid is copious or highly acidic and the mucus barrier cannot cope.

Lifestyle, Illness, Medication and Infection

Any mechanism that can cause one of the following may lead to gastritis and stomach ulcers :

  1. either increases the quantity of acid or its acidity, and/or
  2. decreases the mucus barrier.
It is largely caused by these factors related to lifestyle, medication use, illness and infection.
  • Alcohol and recreational drugs like cocaine
  • NSAIDs (non-steroidal anti-inflammatory drugs)
  • Certain antibiotics
  • Cigarette smoking
  • Helicobacter pylori (H.pylori) infection
  • Depletion of mucus barrier and host defences with illness

What types of stomach problems occur with stress?

Stomach Injury and Ulcers from Stress

Gastritis is a condition where the stomach wall is inflamed. It can be erosive or non-erosive. This means that the stomach wall can be severely inflamed but the lining has not been damaged in non-erosive gastritis. When the stomach wall is worn down and ‘eaten’ away, tiny ulcers and erosions forms in the stomach wall. This is erosive gastritis. The ulcers that arise are commonly referred to as gastric ulcers or stomach ulcers.

The stomach is unlikely to be affected in isolation. Often the first part of the small intestine (duodenum) and lower part of the esophagus (gullet) are also affected. Therefore the term peptic ulcer disease is used to collectively refer to ulcers in the esophagus, stomach and duodenum. In fact, duodenal ulcers are more common than stomach ulcers.

How is stress gastritis and stress ulcers treated?

Medical Treatment

Stress-induced gastritis and stress ulcers are treated medically with :

  • Antacids to neutralize stomach acid when highly acidic or in excess.
  • Proton pump inhibitors and H2-blockers to reduce stomach acid secretion.
  • Antibiotics for H.pylori eradication when infection is present.

Treating Stress

Although stress-induced gastritis and stress ulcers require decisive medical intervention, these stomach problems when associated with psychological stress can be managed without medication in the long term. It should first be treated medically and then the focus should be on preventing a recurrence. Stress management is the key. Lifestyle changes that arise with psychological stress needs to be identified as possible contributors to stomach problems and stopped. For example, alcohol and NSAIDs must be used in moderation and not as a means to ease stress.

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