Chronic duodenal ulcer, marital status and personality pattern. A case-control study

Abstract The aim of the study was to assess the association of chronic duodenal ulcer (DU) with marital status and psychological factors. Sixty-six consecutive patients with DU were compared with 66 randomly selected age, sex, and social-grade matched community controls, with regard to marital status and personality profile. Personality was assessed at interview by the Spielberger State-Trait Anxiety Questionnaire, Beck Depression Inventory, Costello-Comrey Personality Questionnaire and the Eysenck Personality Inventory.
It was found that patients with higher scores on the Beck Depression Inventory and patients who were unmarried were significantly more likely to have DU (odds ratio = 1.2 and 3.3, respectively). None of the other psychometric measures were statistically significant on a multivariate analysis. However, the absolute differences observed and the odds ratio for depression were small. The results suggest that the psychological factors studied were of only minor clinical importance in DU.     

Life events stress and psychosocial factors in men with peptic ulcer disease. A multidimensional case-controlled study

We carried out a case-controlled study of multiple psychological and social factors in 49 men with complicated or uncomplicated peptic ulcer disease. Thirty-two men with renal stones or gallstones and 20 healthy men served as controls. Ulcer patients and controls experienced a similar number of potentially stressful life events. However, ulcer patients perceived their events more negatively (p less than 0.05). Ulcer patients also had significantly more personality disturbances than controls, although no one type of "ulcer personality" was found consistently. Some ulcer patients tended to be hypochondriacal complainers, overly pessimistic, and excessively dependent. Other personality disturbances were also more common in ulcer patients (e.g., immaturity, impulsivity, and feelings of social isolation and alienation). Ulcer patients had significantly lower ego strength and they had fewer friends and relatives whom they felt they could call upon in times of crisis. Finally, ulcer patients exhibited significantly more emotional distress in the form of depression and anxiety. Hypochondriasis, a negative perception of their life events, dependency, and lowered ego strength were the four variables that best discriminated ulcer patients from controls. This controlled study demonstrates a strong association between life events stress, psychosocial factors, and peptic ulcer disease.     

Life events and daily stress in duodenal ulcer disease. A prospective study of patients with active disease and in remission.

Life events and daily stress were assessed in patients with duodenal ulcer, active or in remission, and in matched disease and normal controls. The mean positive life event scores were significantly lower in duodenal ulcer patients than in disease and healthy controls, and lower in patients with active ulcer than in those in remission. The positive scores and total life change scores decreased significantly after 6 months in the control groups and showed no significant variation in the duodenal ulcer group after 6 months. We conclude that the perception of life events, especially positive ones, is associated with duodenal ulcer.     

Life events, personality and dementia

Etiopathogeny of dementia is presently considered as multidimensional, involving genetic, biological and psychological factors. This study was aimed to find out if life events and personality are risk factors for dementia and varied according to the type of dementia. 54 subjects meeting the DSM IV criteria for dementia were included and compared to 54 cognitively controls. 25 patients had dementia of Alzheimer type, 17 frontotemporal dementia and 12 vascular dementia. Data collection was performed using various questionnaires filled in by the patients and caregivers: questionnaire EVVIE for life events, the French version of the personality traits (VKP) for the assessment of personality, a questionnaire for diagnosing alexithymia (EFEA), the mini-geriatric depression scale for depression, and the Neuropsychiatric Inventory for behavioural disorders. Cognitive function was assessed by the Mini Mental State Examination, and the Global Deterioration Scale. Significant differences were found between people suffering from dementia and controls for the frequency and impact of several life events occurred during childhood, marital or professional life. Some qualitative but no quantitative differences in life events experienced were found between patients with different types of dementia. People suffering from dementia had significant personality traits higher than controls such as passivity, avoidance, obsessive features and alexithymia. However, no difference was found in personality traits between subjects with the different types of dementia. These results suggest that psychosocial cumulative stress and personality could constitute a risk factor for dementia, which could be mediated by a dysregulation in the HPA axis.     

Life events stress and psychosocial factors in men with peptic ulcer disease. II. Relationships with serum pepsinogen concentrations and behavioral risk factors

We examined in a controlled study whether psychologic disturbances in men with peptic ulcer disease were related to other potential ulcer "risk factors" (serum pepsinogen concentrations, cigarette smoking, and intake of alcohol, aspirin, or coffee). Psychopathology in general, personality features of hostility, irritability, and hypersensitivity, and impaired coping ability (low ego strength) each correlated significantly with serum pepsinogen concentration in ulcer patients (p less than or equal to 0.005). Cigarette smoking and intake of alcohol and aspirin were increased in ulcer patients but unrelated to psychopathology. Depression was the variable that best discriminated ulcer patients from nonulcer controls; a negative perception of life events, number of relatives with ulcer, and serum pepsinogen I concentration also had a major, unique discriminating value, whereas smoking played a relatively minor role independent of the other variables examined. Our study supports the concept that several interacting factors (psychologic, behavioral, and genetic/physiologic) are likely involved in peptic ulcer disease. Emotional stress may predispose to ulcers by producing gastric hypersecretion, as manifested by hyperpepsinogenemia.     

RUDER—A prospective,two-year,multicenter study of risk factors for duodenal ulcer relapse during maintenance therapy with ranitidine

In a prospective study of the risk factors for duodenal ulcer relapse during maintenance (150 mg daily) ranitidine therapy, 1899 patients with chronic ulcer disease were recruited to a multicenter, German trial. Healing of all ulcers was confirmed endoscopically; endoscopy was also obligatory after one and two years or if the patients presented in the interim with symptoms of ulcer relapse. By the end of the first year, 247 patients had experienced at least one relapse and, by the end of the second year, 432 patients had relapsed at least once. The crude one- and two-year relapse rates were 13.0% (95% CI 11.5–14.5) and 22.7% (20.9–24.6%), respectively. Univariate analysis indicated that all seven prospectively defined risk factors were associated with an increased two-year relapse rate; of these, duodenal erosions distant from the healed ulcer [odds ratio (95% CI): 2.23 (1.59–3.15);P<0.0001], smoking, past or present [1.46 (1.12–1.90);P=0.0050], psychological stress [1.38 (1.09–1.74);P=0.0085], heavy physical labor [1.45 (1.06–1.98);P=0.0219], and absence of NSAID intake [1.54 (1.01–2.29);P=0.0464] were independent risk factors on stepwise logistic regression analysis, whereas persistent symptoms at healing [1.29 (1.03–1.62),P=0.0310] and frequent prior relapses [1.45 (1.01–2.04);P=0.0454] were not. Multiple relapses in 107 patients [5.63% (4.60–6.67%)] were associated with duodenal erosions, smoking, stress, and heavy physical labor. The effects of the five independent risk factors were cumulative: two-year relapse rates increased from 15.7% (95% CI 11.3–20.0%) in the presence of no or one risk factors to 40.9% (26.0–55.7%) in the presence of four or five risk factors.     

Individualized treatment of duodenal ulcer disease. A pilot study.

A substantial number of duodenal ulcer (DU) patients relapse despite maintenance treatment with antisecretory drugs. The influence of certain risk factors and the heterogeneity of the disease could explain such behavior. The present prospective, open study compares the one-year clinical outcome (with upper GI endoscopy at the beginning of the study, at 6 and 12 months, and at every symptomatic relapse) of four groups of DU subjects, consecutively recruited from December 1987 to December 1988, separated in accordance with whether or not a bleeding DU episode had previously occurred, and whether or not an evaluation of gastric acid secretion had been made. Thus, Group I (17 patients; 12 males, 5 females) included heavy smokers and/or gastric acid hypersecretors; Group II (13 patients; 12 males, 1 female) non- or light smokers non-hypersecretors; Group III (34 patients; 22 males, 12 females) subjects with unknown gastric acid secretion; Group IV (33 patients; 30 males, 3 females) previously bleeding DU patients. All patients, except those in Group II (who were left untreated), were given ranitidine 150 mg at bedtime. The outcome of Groups I+II was compared with that of Group III (considered as "standard therapy") and Group IV patients, the latter presumably with a low risk of relapse because of the low prevalence of smokers. Statistics: Chi-square test, Fisher's exact test, analysis of variance and the logrank test. During the year of follow-up, 27/97 patients withdrew from the study, while 18 had a DU relapse (remission rates 82.1% +/- 7.4% in Groups I+II, 70.5% +/- 8.4% in Group III, 87.5% +/- 5.9% in Group IV).(ABSTRACT TRUNCATED AT 250 WORDS)     

Elevated serum pepsinogen I and II levels differ as risk factors for duodenal ulcer and gastric ulcer

We investigated the possibility that serum pepsinogen I (PG I) and pepsinogen II (PG II) levels might differ as risk factors for duodenal ulcer and gastric ulcer. From 1967 to 1970, serum was obtained from 7498 Japanese men in Hawaii, and the cohort was followed up to 1981 for the development of peptic ulcer disease. Pepsinogen I and PG II levels in stored serum were significantly higher in the subjects who developed duodenal ulcer (n = 43) or gastric ulcer (n = 115) than in 212 control subjects. The linear trend in risk of each type of ulcer was highly significant for both PG I and PG II. An elevated serum PG I level (greater than or equal to 130 micrograms/L), however, was associated with about a threefold higher odds ratio for duodenal ulcer than for gastric ulcer (8.37 vs. 2.83), whereas an elevated PG II level (greater than or equal to 30 micrograms/L) was associated with about a threefold higher odds ratio for gastric ulcer than for duodenal ulcer (18.21 vs. 6.49). In contrast, the PG I/PG II ratio was significantly lower in the gastric ulcer than in the control and duodenal ulcer cases, and showed a significant linear trend in risk only for gastric ulcer. In addition, a PG I/PG II ratio of less than 4.0, which has been shown previously to be indicative of chronic gastritis, was associated with an almost 10-fold higher odds ratio for gastric ulcer than for duodenal ulcer (7.35 vs. 0.79). The results indicate that an elevated serum PG I level is a major risk factor for duodenal ulcer, whereas an elevated serum PG II level and a low PG I/PG II ratio are major risk factors for gastric ulcer.     

The incidence of gastric ulcer and duodenal ulcer in north Norway. A prospective epidemiological study

From a prospective epidemiological study of peptic ulcer disease in the northern part of Norway, incidence rates for gastric and duodenal ulcer are presented. Over a 3-year period 4234 patients were examined radiologically or endoscopically. The population at risk was 72,537 persons, 16 to 93 years old. The yearly incidence rate for gastric ulcer in women was 0.9 per 1000 and for men 1.4 per 1000. For duodenal ulcer the incidence rates were 0.8 and 1.5 per 1000, respectively. The ratio of gastric ulcer to duodenal ulcer is still 1 to 1.1 for both sexes, 1 to 0.9 in women, and 1 to 1.14 in men in the northern part of Norway. Furthermore, the present study indicates a statistically significant positive correlation between increasing age and the occurrence of peptic ulcers for both sexes.     

Type A personality and risk of post-infarction coronary events

The purpose of this study was to verify the prevalence of Coronary-prone Behaviour Pattern in a group of eighty-eight patients recovering from their first episode of myocardial infarction. These patients were followed for a period of 4 years to verify the eventual appearance of coronary events, after their first myocardial infarction, with high Coronary-prone Behaviour Pattern levels. The results showed that the number of subjects who died from recurrent myocardial infarction was nearly twice as high in type B, non coronary-prone subjects, as in type A subjects. The Authors hypothesize that specific ways of coping with stressful events adopted by type A subjects may constitute a protection factor as regards the risk of death from recurrent myocardial infarction.     

Life events and neurocirculatory asthenia. A controlled study

Sonino N, Fava GA, Boscaro M, Fallo F (University of Padova, Padova, University of Bologna, Bologna, Italy; and State University of New York at Buffalo, NY USA). Life events and neurocirculatory asthenia. A controlled study. J Intern Med 1998; 244 : 523–8.
Objectives : The purpose of this study was to assess the occurrence of stressful life events in the year before the onset of neurocirculatory asthenia.
Design : Case-control retrospective study.
Setting : A university medical outpatient clinic.
Subjects : A consecutive series of 50 patients with neurocirculatory asthenia and a control group of 50 healthy subjects, matched for sociodemographic variables, were studied.
Main outcome measures : Paykel's Interview for Recent Life Events (a semistructured research interview covering 64 life events) was administered to patients and controls.
Results : Patients with neurocirculatory asthenia reported significantly more stressful life events than the control group ( P  < 0.05) and had significantly more of the following: exits ( P  < 0.05), undesirable ( P  < 0.05) and uncontrolled ( P  < 0.01) events. More events that had an objective negative impact ( P  < 0.001) and more independent events ( P  = 0.07) were also reported. Ratings of impact and independence were carried out by a blind rater who was unaware whether the event had occurred in patients or controls.
Conclusions : The results are suggestive of a strong relationship between stressful life events and neurocirculatory asthenia. This is in agreement with a multifactorial model of pathogenesis in neurocirculatory asthenia and with current understanding of the extensive links of behavioral responses to stress with neurophysiological and biochemical processes.     

The personality pattern of duodenal ulcer patients in relation to spontaneous ulcer healing and relapse

One hundred consecutive out-patients with duodenal ulceration from a hospital and a gastroenterological clinic were tested with the Minnesota Multiphasic Personality Inventory (MMPI). This was carried out in order to investigate whether neuroticism or other personality disorders were characteristics of duodenal ulcer patients, and whether the presence of such possible personality disorders might influence the prognosis of the disease. Neuroticism occurred in 53% of the patients, but only in 5% of controls (P less than 0.0001). Overall, personality disorders were present in 69% of the patients compared with 30% of the controls (P less than 0.0001). Neuroticism was connected with a high frequency of relapse (P less than 0.05) whereas failure of spontaneous ulcer healing had no certain relation to personality disorders. Patients with non-neurotic personality disorders had more frequently suffered stressful life events before entrance to the study (P less than 0.05) and, like the neurotic patients, they had lower ego-strength to cope with such events (P less than 0.05). The results indicate that personality assessments make it possible to distinguish between subgroups of duodenal ulcer patients with different course of the disease.     

Social aspects of chronic duodenal ulcer. A case control study

A case-control study of 80 patients with duodenal ulcer and 80 community controls was undertaken to compare these two groups regarding social and environmental factors including socio-economic status, marital status, country of birth, childhood and family factors. An increased risk of duodenal ulcer was associated with status incongruity in males; the male patients, when matched on suburb of residence, having lower status occupations than controls, and when matched on occupational status, tending to have lower educational levels than controls. Being unmarried was associated with an increased risk of duodenal ulcer in females. The number of siblings was also a risk factor in the male patients, those with more than 5 siblings being at an increased risk. Factors not associated with duodenal ulcer included country of birth, childhood happiness, sibling sequence and family stability. In conclusion, the factors associated with chronic duodenal ulcer were found predominantly in adult life and could produce their adverse effects by causing chronic stress which may be more relevant than acute stress as produced by major life events.     

Perception of life event stress in patients with chronic duodenal ulcer. A comparison of the rating of life events by duodenal ulcer patients and community controls

Stress is often claimed by doctors and patients to be an aetiological factor in peptic ulcer disease. The aim of the present study was to investigate whether ulcer patients perceive that they would react more strongly than normal to life event stress. Seventy-three patients with duodenal ulcer and their sex- and age-matched controls rated 81 events for the amount of distress and life change they considered the events would cause them personally. With regard to individual events, only one difference emerged: female patients rated promotion at work significantly lower for distress than did controls, when event experience was taken into account. There was a systematic tendency for ratings of male patients to be lower than those of controls. These observations suggest that duodenal ulcer patients do not perceive that their reaction to life events would be in excess of normal.     

十二指肠球部溃疡治疗的费用效果分析

目的比较两种治疗方案（ＯＡ：奥美拉唑＋阿莫西林；ＡＭＴ：阿莫西林＋甲硝唑加泰胃美）愈合十二指肠球部溃疡，根除幽门螺杆菌（Ｈｐ）感染，减少溃疡复发的效率（即费用＿效果）．方法１９９５年采用随机对照临床试验ＯＡ组４６例，ＡＭＴ组４３例，作为分析模型，以上海市三级甲等医院的收费为标准，进行费用＿效果分析．结果ＡＭＴ方案平均每愈合１例溃疡的费用为５４６２５元，较ＯＡ方案节约７５０５１元；每根除１例Ｈｐ感染的费用为７０２３２元，较ＯＡ方案节约１０４０２１元；ＡＭＴ＋三联治疗平均每减少１例溃疡复发的费用为６４０３９元，较ＯＡ＋三联治疗节约７８４１５元．在全部费用中直接医疗费用占绝大部分，且其中主要是首次治疗药品费用．ＯＡ方案与ＡＭＴ方案的费用差别主要由首次治疗的药品费用引起．直接非医疗费用及间接费用在二种方案之间无明显差别．结论同时考虑临床疗效及医疗费用，ＡＭＴ治疗较ＯＡ治疗有更好的费用＿效果，尤其对单发，直径在１ｃｍ及以下的十二指肠球部溃疡优于ＯＡ方案治疗，值得临床推广应用．     

Multivariate analysis of risk factors for development of duodenal ulcer in Helicobacter pylori-infected patients

BACKGROUND: Although Helicobacter pylori is a significant etiologic factor of peptic ulcer disease, it remains unknown why ulcers develop only in the minority of infected individuals. AIM: The aim of this cross-sectional study was to evaluate the association between the presence of duodenal ulcer in H. pylori-infected patients and different risk factors. METHODS: A total of 122 H. pylori-infected patients were enrolled; 79 had duodenal ulcer and 43 gastritis. Univariate analysis was conducted using either Fisher's exact test or exact Cochrane-Armitage trend test. In multivariate analysis the logistic model was used. RESULTS: Univariate analysis indicated six factors (male sex, smoking, antral H. pylori density, CAGA presence in antrum, and VACA s1a presence in antrum and corpus). Four factors (sex, smoking-alcohol index, H. pylori density index, and CAGA index) were found to be significant in multivariate analysis. The best model predicting duodenal ulcer included male sex, smoking, presence of H. PYLORI on histopathology in antrum and CAGA presence in corpus. CONCLUSION: Although several risk factors were significantly associated with duodenal ulcer, we failed in the identification of either a single risk factor or a set of factors that can unequivocally differentiate patients with ulcer from those with gastritis.