Epidemiology and clinical presentation of stress-related peptic damage and chronic peptic ulcer

Stress is often considered a risk factor for upper gastrointestinal tract disease, as any acute threat to homeostasis evokes an adaptive or allostatic response. Various types of stress may play a role in the onset and modulation of acute or chronic peptic ulcer disease. When upper endoscopy is employed, stress-related acute mucosal damage is found to develop shortly after admission to an intensive care unit in 60 to 100 percent of patients. However, the epidemiology of chronic peptic damage has not been accurately described by type of stressor, and any association is controversial. The incidence of chronic peptic ulcer disease is falling; the proportion of chronic peptic ulcers that are Helicobacter pylori negative appears to be between 5% and 20%, and some have suggested that stress or other psychological factors may play a role here. Therefore, our objective is to provide an overview of the epidemiology and clinical presentation of stress-related peptic damage, in order to shed insights into the current understanding of the pathophysiology and treatment.