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Stress-induced hemorrhagic gastric ulcer after successful Helicobacter pylori eradication: two case reports.

Moriya M, Uehara A, Okumura T, Miyamoto M, Kohgo Y - J Med Case Rep (2011)

Bottom Line: Helicobacter pylori infection is a major cause of gastric ulcers, and Helicobacter pylori eradication drastically reduces ulcer recurrence.It has been reported, however, that severe physical stress is closely associated with gastric ulceration even in Helicobacter pylori -negative patients.Our cases strongly suggest that not only physical but also psychological stress is still an important pathogenic factor for peptic ulceration and accordingly that physicians should pay attention to the possible presence of psychological stress in the management of patients with peptic ulcers.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Psychosomatic Internal Medicine, Health Sciences University of Hokkaido, Japan. moriyami@pop21.odn.ne.jp.

ABSTRACT

Introduction: Helicobacter pylori infection is a major cause of gastric ulcers, and Helicobacter pylori eradication drastically reduces ulcer recurrence. It has been reported, however, that severe physical stress is closely associated with gastric ulceration even in Helicobacter pylori -negative patients.

Case presentation: We report the cases of a 47-year-old Japanese man and a 69-year-old Japanese man who developed psychological stress-induced hemorrhagic gastric ulcers, in both of whom Helicobacter pylori had been successfully eradicated.

Conclusion: Our cases strongly suggest that not only physical but also psychological stress is still an important pathogenic factor for peptic ulceration and accordingly that physicians should pay attention to the possible presence of psychological stress in the management of patients with peptic ulcers.

No MeSH data available.


Related in: MedlinePlus

Esophagogastroduodenoscopic findings. (A) Case 1: An open gastric ulcer with an exposed vessel. (B) Case 2: A recurrent gastric ulcer without active bleeding.
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Figure 1: Esophagogastroduodenoscopic findings. (A) Case 1: An open gastric ulcer with an exposed vessel. (B) Case 2: A recurrent gastric ulcer without active bleeding.

Mentions: A 47-year-old Japanese man had been admitted to the hospital for hematemesis and tarry stools 14 years ago. He had a medical history of gastric ulcer and had received Hp eradication therapy two years before his current presentation. Since then, he had been taking the H2 blocker famotidine (40 mg/day) for the prevention of ulcer recurrence. He denied use of NSAIDs or aspirin, smoking and drinking alcohol. Three days before his hospitalization he had been involved in a life-threatening accident in which his boat was overturned and he almost drowned. Afterward he was too agitated to sleep for the following three days. Laboratory findings showed mild anemia (hemoglobin 12.0 g/dL), elevated blood urea nitrogen (BUN) (27.9 mg/dL) and normal gastrin (150 pg/mL). An esophagogastroduodenoscopy demonstrated an open gastric ulcer with an exposed vessel (Figure 1A). We immediately performed endoscopic hemostasis procedures against the exposed vessel in the base of the gastric ulcer, using a heat probe coagulation method together with local injections of hypertonic saline epinephrine solution and absolute ethanol. The clinical course of the patient was uneventful after endoscopic therapy. Three Hp-associated examinations, that is, rapid urease test, histology and bacteriology, were all negative. As to a mind-body correlation, the patient displayed a typical type A behavior pattern [4]. The psychophysical stress he experienced in the life-threatening boat accident was so enormous that he was extremely agitated and could hardly sleep. It was speculated that this strong emotional stress induced the recurrence of hemorrhagic gastric ulcer, even though he had been under maintenance therapy with H2 blockade after successful Hp eradication.


Stress-induced hemorrhagic gastric ulcer after successful Helicobacter pylori eradication: two case reports.

Moriya M, Uehara A, Okumura T, Miyamoto M, Kohgo Y - J Med Case Rep (2011)

Esophagogastroduodenoscopic findings. (A) Case 1: An open gastric ulcer with an exposed vessel. (B) Case 2: A recurrent gastric ulcer without active bleeding.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3141705&req=5

Figure 1: Esophagogastroduodenoscopic findings. (A) Case 1: An open gastric ulcer with an exposed vessel. (B) Case 2: A recurrent gastric ulcer without active bleeding.
Mentions: A 47-year-old Japanese man had been admitted to the hospital for hematemesis and tarry stools 14 years ago. He had a medical history of gastric ulcer and had received Hp eradication therapy two years before his current presentation. Since then, he had been taking the H2 blocker famotidine (40 mg/day) for the prevention of ulcer recurrence. He denied use of NSAIDs or aspirin, smoking and drinking alcohol. Three days before his hospitalization he had been involved in a life-threatening accident in which his boat was overturned and he almost drowned. Afterward he was too agitated to sleep for the following three days. Laboratory findings showed mild anemia (hemoglobin 12.0 g/dL), elevated blood urea nitrogen (BUN) (27.9 mg/dL) and normal gastrin (150 pg/mL). An esophagogastroduodenoscopy demonstrated an open gastric ulcer with an exposed vessel (Figure 1A). We immediately performed endoscopic hemostasis procedures against the exposed vessel in the base of the gastric ulcer, using a heat probe coagulation method together with local injections of hypertonic saline epinephrine solution and absolute ethanol. The clinical course of the patient was uneventful after endoscopic therapy. Three Hp-associated examinations, that is, rapid urease test, histology and bacteriology, were all negative. As to a mind-body correlation, the patient displayed a typical type A behavior pattern [4]. The psychophysical stress he experienced in the life-threatening boat accident was so enormous that he was extremely agitated and could hardly sleep. It was speculated that this strong emotional stress induced the recurrence of hemorrhagic gastric ulcer, even though he had been under maintenance therapy with H2 blockade after successful Hp eradication.

Bottom Line: Helicobacter pylori infection is a major cause of gastric ulcers, and Helicobacter pylori eradication drastically reduces ulcer recurrence.It has been reported, however, that severe physical stress is closely associated with gastric ulceration even in Helicobacter pylori -negative patients.Our cases strongly suggest that not only physical but also psychological stress is still an important pathogenic factor for peptic ulceration and accordingly that physicians should pay attention to the possible presence of psychological stress in the management of patients with peptic ulcers.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Psychosomatic Internal Medicine, Health Sciences University of Hokkaido, Japan. moriyami@pop21.odn.ne.jp.

ABSTRACT

Introduction: Helicobacter pylori infection is a major cause of gastric ulcers, and Helicobacter pylori eradication drastically reduces ulcer recurrence. It has been reported, however, that severe physical stress is closely associated with gastric ulceration even in Helicobacter pylori -negative patients.

Case presentation: We report the cases of a 47-year-old Japanese man and a 69-year-old Japanese man who developed psychological stress-induced hemorrhagic gastric ulcers, in both of whom Helicobacter pylori had been successfully eradicated.

Conclusion: Our cases strongly suggest that not only physical but also psychological stress is still an important pathogenic factor for peptic ulceration and accordingly that physicians should pay attention to the possible presence of psychological stress in the management of patients with peptic ulcers.

No MeSH data available.


Related in: MedlinePlus