When Tom Cruise recently told ABC’s Diane Sawyer that he developed an ulcer while filming “Eyes Wide Shut,” he joined the ranks of 25 million Americans suffering from those painful erosions of the lining of the stomach and upper intestine.
According to conventional medical thinking, Cruise’s problem had nothing to do with nerves and everything to do with bacteria.
Since the mid-1980s, stress has been discounted as the cause of ulcers, and the widespread belief in traditional medical circles has been that ulcers are caused by one of two factors: a bacterium called Heliocobacter pylori (H. pylori for short) or problems from the use of ibuprofen and other non-steroidal anti-inflammatory drugs (NSAIDS).
But now there’s talk once again that stress–observing steamy, nude love scenes, for instance–does play an important role in creating ulcers and keeping them churning.
In fact, the question of a stress connection to ulcers is becoming a hot topic in medicine.
Dr. Andrew Weil, a Harvard-educated physician and director of the Program in Integrative Medicine at the University of Arizona, is also the author of best-selling books that offer advice on herbal medicine, nutrition and lifestyle. Weil is one of those who believe stress can play an integral part in the development of ulcers.
In the May 1999 edition of “Dr. Andrew Weil’s Self Healing” newsletter, which has a circulation of 370,000, he writes: “With the lining of the stomach under complex control by the autonomic nervous system . . . it is logical that stress could increase tissue susceptibility to bacterial attack.”
Indeed, there are documented reports of increases in ulcers following particularly stressful events, including German air raids on London during World War II, the massive earthquake in Kobe, Japan, in January 1995, and even the more recent sovereignty negotiations in Hong Kong.
Dr. Kevin Regan, a Chicago chiropractor and acupuncturist who has treated several ulcer patients, says he doesn’t have to look far to see a link to stress.
“Is there a connection between stress and ulcers? Absolutely,” he says. “Stress is a driving force that gets you out of bed, gets you to pay the bills, and that’s good stimulus to do positive things. But when there’s excess stress, the body reacts, usually through the nervous system.”
And that’s where the problem may begin.
“Under stress, the body can’t fight off infection,” says Dr. David Zeiger, an osteopathic physician and medical director of the downtown office of American Whole Health.
He points to the adrenal gland specifically as a key player.
“The adrenal gland responds to stress by releasing the hormone cortisol,” he explains. “High levels of cortisol will suppress the production of SIga, an important immune protein, therefore lessening the body’s ability to fight off environmental allergens.”
Zeiger says high levels of cortisol also interfere with the body’s ability to produce mucous, which acts as a barrier to stomach acid. He calls it a downward spiral.
“Stress creates an internal environment that promotes and sustains bacteria that promote more breakdown,” he says. “You get an ulcer, it gets worse and bleeds and trouble continues.”
When holistic practitioner Regan met Chicagoan Kim Hoffman, a working single mom and college student in her late 30s, it didn’t take him long to conclude stress played a crucial role in her ulcer.
“I had had a lot of tension,” Hoffman explains. “I was in a relationship that wasn’t good, I started college, got a new job and my sister had a terrible accident all at the same time.”
Hoffman had spent years taking antacids to treat the stomach pain. She says she was tested for H. pylori , about two years ago but such a tiny amount of the bacteria was found, doctors told her it couldn’t possibly be causing the incredibly severe pain she was having. They diagnosed the pain in her stomach to be all in her head.
Regan says he used a holistic approach, treating Hoffman’s body as a whole, not just treating her ulcer.
“He gave me a lot of chiropractic manipulation for tension, especially in my neck because I could hardly move my head,” Hoffman says.
Regan also started her on a regimen of minerals and herbs to build up her immune system. He cites ginger, rhubarb and the Chinese herb coptis as the most stomach-friendly, ulcer-fighting herbs.
“In six months, I’d recovered,” Hoffman says, “not just from my ulcer, but from other stress-related symptoms” such as headaches and neck aches.
Zeiger, too, recommends herbal therapy, including deglycyrrhizinated licorice, a natural product he says can help rebuild the stomach lining by increasing that protective layer of mucous — without the side effects of antacids, which include nausea, gas and indigestion.
It’s available in chewable tablets and is a big seller at health food stores. Zieger also says several widely published studies show herbs including garlic and echinacea can wipe out H. pylori.
Regan adds acupuncture to the list of alternative therapies for treating ulcers.
“With ulcers, there’s too much energy, too much stimulation of the nervous system that regulates the intestinal tract,” he says. “Acupuncture interrupts the pathway of stimulation.”
And, he says, patients get the best results from herbs and acupuncture when they’re used together.
“The tissue needs the herb as well as the needle. They do the same thing, by balancing energy.”
But not everyone makes the ulcer-stress connection.
“Recent data suggests that stress plays a minimal or no role at all in the causation of ulcers,” says Dr. Jay Goldstein, a gastroenterologist and associate professor of medicine at the University of Illinois at Chicago Medical Center.
“It’s estimated that well over 90 percent of stomach and duodenal ulcers (those found in the upper intestine) are caused by H. pylori or NSAIDS,” Goldstein says. “However, patients who have stress often have symptoms that mimic those seen with ulcer disease, but in fact, ulcers are not present.”
Goldstein says most physicians understand that when an ulcer is present, reduction of stress may allow patients to better cope with their symptoms, but that there’s no evidence stress reduction will heal ulcers any faster or without medication.
One of the most successful treatments for ulcers, according to Goldstein, involves the eradication of H. pylori via an antibiotic “cocktail.” The first ingredient is a combination of at least two antibiotics. Some of the commonly used drugs are familiar: biaxin, tetracycline and amoxicillin.
Then a combination of acid suppressors is added. It could include medications such as Prilosec or Zantac, as well as bismuth, a substance similar to Pepto-Bismol. The acid blockers open the door for the antibiotics to work.
Versatility is an important advantage.
“The cocktails give us more options,” Goldstein says. “For example, if someone is allergic to one antibiotic, others can be found.”
Just the right combination helped Sarah Grandberry, a 57-year-old self-employed seamstress from Chicago.
“Two years ago, I had pain in my stomach, above the breast bone, and everything I ate seemed to give me heartburn. I figured I was eating too much spicy chili,” she says. “I tried to take it with a grain of salt; I figured I’m just getting older and things happen.”
But eventually the pain got too strong to ignore.
Grandberry says she was surprised to learn she had an ulcer, and even more surprised when she was told it was caused by bacteria.
An antibiotic cocktail treatment was just what the doctor–Goldstein–ordered.
Grandberry she says it didn’t take long for her to feel better.
“After just days my pain was gone,” she says, “and . . . it hasn’t returned.”
In some cases, the medications taken for one health problem can cause another.
Dennis Ryes, a 41-year-old self-employed race car builder from Portage, Ind., says he has suffered from arthritis of the hip “for what seems like forever.”
Trying to ease the arthritis with anti-inflammatory drugs only made his stomach feel awful.
“I suffered for years and tried all sorts of things–aspirin, ibuprofen, arthritis pills, even cortisone shots,” he says. “You name it, I tried it, and all that was happening was that it was burning a hole in my stomach. All the medications even say `may cause ulcers.’ That makes you feel great.”
Ryes hadn’t yet developed an ulcer, but he was certain he was on his way.
So he became a participant in the trial of a new type of anti-inflammatory called a COX-2 inhibitor.
“Preliminary long-term studies have suggested there is an eight-fold reduction in bleeding ulcers and other ulcer complications in patients using COX-2 inhibitors, compared to traditional NSAID medications,” Goldstein says.
Two COX-2 inhibitors on the market now are Celecoxib, known as Celebrex and Rofecoxib, with the brand name Vioxx. Both are available by prescription.
Ryes started taking Celebrex about two years ago.
“What do I like about it?” he says. “The stuff does work on my arthritis, and it doesn’t upset my stomach. There are no side effects.”
The very best effect, he says, is that it has given him freedom.
“I’ve actually cut loose a bit,” he says. “I was in pain for so long, it was a chore to go to work. Now I own my own business, I’m riding dirt bikes again, I exercise, I feel free.”
SEPARATING FACT FROM FANTASY
There may be more myths about ulcers than any other ailment around. Here are a few:
MYTH: Ulcers are for adults only.
FACT: Actually, anyone can get them. Dr. Jay Goldstein, a gastroenterologist and associate professor of medicine at the University of Illinois at Chicago Medical Center, says he has seen ulcers in children as young as 6 months old.
“Ulcers are transmitted when bacteria is passed through close exposure from person to person,” he says.
So yes, kids can get ulcers from their parents.
“But I still want all moms and dads to kiss their babies,” Goldstein says.
MYTH: Skip the spicy stuff.
FACT: Perhaps the most common myth about ulcers is that they’re caused by gobbling late-night pizzas and sneaking the chips and hot salsa. Holistic practitioners say food is a factor, but not necessarily the type of food you might think.
Better to chomp on the chili, but cancel the carbs and dump the dairy. Dr. David Zeiger, an osteopathic physician and medical director of the downtown office of American Whole Health in Chicago, says dairy products and carbohydrates can weaken the immune system and contribute to inflammatory diseases including arthritis, asthma and, yes, ulcers.
MYTH: It’s a male disease.
FACT: According to the Centers for Disease Control and Prevention in Atlanta, 25 million Americans suffer from an ulcer, and the center’s research shows women are affected by ulcers just as often as men.
MYTH: The presence of Helicobacter pylori bacteria always means an ulcer.
FACT: Not everyone who has H. pylori (a bacteria usually associated with ulcers) in his system develops an ulcer. Research shows about 60 percent of all Americans are infected with the bacterium, but only about 20 percent get ulcers.
MYTH: Cats and dogs are immune.
FACT: “Animals can get ulcers,” says Dr. Scott Petereit, a veterinarian with Animal Medical Center Chicago.
And there are some similarities to humans.
“We do find Helicobacter pylori in cats and dogs,” Petereit says.
“Research implies it could potentially be causing ulcers. But when you find ulcers in dogs, for example, most of the time it’s caused by owners giving the pet ibuprofen and other non-steroidal anti-inflammatory drugs. It’s best to call the vet and not prescribe for your pet.”
