"The identification of Helicobacter pylori as an infectious cause of peptic ulcer disease has been considered by many to disprove the possibility that there is an important relationship between anxiety disorders and gastrointestinal disease," says study author Renee D. Goodwin, Ph.D., from the Department of Epidemiology at the Mailman School of Public Health at Columbia University in New York City.
"Over the last several years research on the causes and treatments for peptic ulcer disease has neglected the links with psychiatric/psychological factors," she notes.
Goodwin and co-author Murray B. Stein, M.D., from the Department of Psychiatry at the University of California at San Diego in California, analyzed data from the National Comorbidity Survey, a household survey of U.S. individuals aged 15 to 54, to determine the relationship between generalized anxiety disorder and ulcers.
Generalized anxiety disorder affects between 3 percent and 4 percent of the population, and is characterized by unremitting worry, dread and lack of energy. A peptic ulcer is a sore in the lining of the stomach or small intestine. More than 25 million Americans suffer from an ulcer during their lifetime, according to the Centers for Disease Control and Prevention.
Goodwin and Stein found that generalized anxiety disorder was associated with a significantly increased risk of self-reported peptic ulcer disease. They also found that the more anxiety symptoms reported by the generalized anxiety sufferers, the more likely they were to report peptic ulcer disease.
These study findings support previous research. "The identification of a dose-response relationship between the two disorders offers further support for the hypothesis that the relationship between the two disorders is genuine," says Goodwin. The study results are published in the November/December issue of the journal Psychosomatic Medicine.
The mechanism behind the link is unknown, but the researchers suggested four scenarios. One, the stress side effect of generalized anxiety disorder may cause peptic ulceration. Two, having peptic ulcer disease may somehow lead to an anxiety disorder. Three, an environmental or genetic factor may increase vulnerability to the co-occurrence of the two disorders. Or, four, individuals with generalized anxiety disorder over-report ulcer symptoms, according to the study.
These findings don't disprove the hypothesis that a bacterial infection causes ulcers, but may refine it, according to the study.
"In light of recent data suggesting peptic ulcer disease is caused by exposure to an infectious agent, these data add an interesting perspective," says Goodwin. "If indeed Helicobacter pylori were the sole cause of peptic ulcer disease, it seems unlikely this sort of association would emerge in the data."
It is possible that persistent, severe anxiety and infectious agents may both contribute to the development of peptic ulcers, according to the study. This scenario is supported by laboratory findings that stress, which is associated with generalized anxiety disorder, may affect the body's immune response to bacteria such as Helicobacter pylori.
Goodwin and Stein note study limitations, including that study data was based on self-reports, and individuals with chronic anxiety may over-report their experience of peptic ulcer disease. The data was also based on retrospective reports, which are subject to memory bias.
These findings, if supported by other studies, should increase awareness that patients seeking help for peptic ulcer disease may be at increased risk for generalized anxiety disorder.
"This awareness may improve rates of identification and treatment of this common yet frequently unrecognized anxiety disorder," says Goodwin.
The researchers also note that medications that treat generalized anxiety disorder, such as antidepressants, may have potential for treating peptic ulcer disease, "perhaps in combination with medications that eradicate Helicobacter pylori," according to the study.
Funding for the study and data collection came from the National Institute of Mental Health, the National Institute of Drug Abuse, and the W.T. Grant Foundation.
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Journal
Psychosomatic Medicine