What are stress ulcers? Causes, symptoms, risk factors, treatment

Key takeaways:

• A stress ulcer is an ulcer caused by stress. They occur mostly in the stomach but are different from stomach ulcers.
• Stress ulcers also have symptoms similar to peptic or stomach ulcers. However, they are mostly caused by underlying medical conditions, such as kidney failure and septic shock.
• Stress ulcers are life-threatening but can be treated using medications like proton pump inhibitors and histamine-blocker drugs.

Stress ulcers never happen by chance; they are always caused by things that put the body under a lot of physical stress. Anyone can develop stress ulcers; people who have experienced severe trauma like burns, organ problems, or injury to certain parts of the body are at a higher risk of developing them.

If you have any health condition like liver failure, kidney failure, or peritonitis, you should pay attention to your gut health. If you notice the symptoms of a stress ulcer, you should let your doctor know right away.

Moving further into this article, we will discuss the link between stress and ulcers, how stress ulcers develop, their causes, and risk factors.

Meaning of stress ulcer

Stress ulcers are small wounds or sores on the surface of the GI tract, especially in the fundus (body) of the stomach. They often show up in more than one place on the wall of the stomach as erosions or sores, which do more damage to the lining of the GI tract.

Stress ulcers, like peptic ulcers, affect the lining of the stomach, but their causes differ.

While peptic ulcers (ulcers that affect the lower esophagus, stomach, and small intestine) often occur gradually as infections by H. pylori bacteria or medications weaken the stomach lining, stress ulcers emerge suddenly due to severe physical or physiological stress. This is one of the major differences between stomach ulcers and stress ulcers.

People with stress ulcers often feel like their stomachs are on fire and hurt there. They are also at an increased risk of infection and may experience severe bleeding.

Although stress can worsen stomach ulcers, stomach ulcers are often not as severe and life-threatening as stress ulcers, which occur suddenly and require urgent treatment.

Link between stress and ulcer: How does stress cause an ulcer?

Stress is not the primary cause of some ulcers like peptic ulcers, but it can be a contributor. Different studies have indicated a link between stress and ulcers.

A study showed that emotional stress, coupled with some psychological factors, can be a huge contributor to peptic ulcers. In another study - a 2014 study published in Clinical Gastroenterology and Hepatology, psychological stress increased the incidence of peptic ulcers, as ulcers were significantly higher among participants with the highest stress scores.

When people are stressed, there is often an urge to take pain relievers like aspirin and ibuprofen, which are NSAIDs. Long-term or excessive usage of non-steroidal anti-inflammatory medications (NSAIDs) is one of the primary causes of peptic ulcers.

Also, when your body is under stress, it tends to increase its production of stomach acid. When there is increased stomach acid, it can lead to stomach wall ulcerations.

How stress ulcers develop

Stress ulcers commonly develop in the body/fundus of the stomach. Stress ulcers can happen after a shock, which hurts the stomach, or sepsis, which is the body's response to an infection. They can also develop due to some health conditions like peritonitis.

Stress ulcers can also develop as a result of physical stress. Stress on the body can damage the lining of the stomach, which can then lead to ulcers.

Another way stress ulcers can develop is when there is an increased level of gastric acid. Stomach acids help in the digestion of food and also perform other physiological functions. However, when the acidity increases, it can cause the lining of the stomach to get damaged.

A 2022 piece on NCBI Bookshelf explains that physiological stress can alter gastric pH (the alkalinity or acidity of the stomach). This, in turn, disrupts the normal digestion process and can lead to stomach inflammation.

In a stressed state, there are increased levels of acetylcholine, a neurotransmitter, and histamine, which both increase stomach acid production, causing damage to the stomach walls.

Causes of stress ulcer

Both physical and physiological factors can cause stress ulcers. Common causes of stress ulcers include:

• Kidney failure - patients with end-stage acute kidney injury often also experience gastrointestinal bleeding
• Liver failure - Patients who suffer liver failure have a chance of getting stress ulcers
• Septic shock - happens when your blood pressure drops to a low level, and it mostly occurs as a result of an infection
• Burns that affect more than 30% of your body surface, either from a fire incident or chemical burns
• A history or medical record of bleeding in your gastrointestinal tract in the past year
• Being on a mechanical ventilator for more than 48 hours

Stress ulcers vs. stomach ulcers

The major difference between stomach ulcers and stress ulcers lies in their causes and the way they develop. Stress ulcers occur due to physical injury or physiological trauma affecting the stomach lining. The injury or sore could be caused by a health problem like peritonitis. Stress ulcers occur spontaneously in the stomach.

On the other hand, stomach ulcers are also injuries or soreness to the lining of the stomach. However, they occur when there is an infection of H. pylori bacteria or excessive use of non-steroidal anti-inflammatory drugs like aspirin and ibuprofen.

Stress can make stomach ulcers worse, but it's not what causes them in the first place.

Also, stomach ulcers tend to get worse over time, while stress ulcers can come on quickly and cause severe pain. Factors like dietary constituents and skipping meals can also affect stomach ulcers.

Stress ulcers vs. gastritis

To better explain the difference between stress ulcers and gastritis, it is best to understand what both terms mean, which is explained in this article.

The main difference between gastritis and stress ulcers also lies in their causes. Stress ulcers are caused by injury or trauma that results from some health conditions, like peritonitis. They cause many small sores and thin erosions to show up, usually on the fundus of the stomach.

On the other hand, gastritis is an inflammation of the lining of the stomach. It occurs when there is damage to the mucosa protecting the stomach, causing sores that are shallower compared to stomach ulcer sores.

Since gastritis is an inflammation of the stomach lining, it causes redness, pain, tenderness, swelling, and other signs of inflammation.

Gastritis can be caused by H. pylori infection, alcohol, or excessive use of non-steroidal anti-inflammatory drugs. Similar to stomach ulcers, diet can also impact gastritis positively or negatively depending on the food.

Symptoms of stress ulcer

Stress ulcers are often a result of other underlying health conditions. So, it may be hard to tell if the symptoms you are having are caused by stress ulcers or something else.

However, the common symptoms of stress ulcers include the following:

• Constant pain in the upper part of your stomach
• A feeling of nausea or vomiting
• Bloating
• Pain in the stomach after eating
• Bleeding in the stomach

A person who is bleeding in their gastrointestinal tract may notice signs and symptoms like:

• A red-colored vomit
• Vomiting dark brown clumpy substance
• Dark stools
• The feeling of lightheadedness

Risk factors for developing stress ulcer

There are some factors that might increase your chances of getting a stress ulcer. Some of the risk factors include:

• When you have an injury in your brain or spinal cord (central nervous system)
• A physical trauma
• Long-term use of non-steroidal anti-inflammatory drugs
• When you experience a severe burn
• Some health conditions like peritonitis
• Some surgical procedures

Treatment for stress ulcer

The best approach to the treatment of stress ulcers is to control stomach acids. To accomplish this, your doctor may prescribe medications such as proton pump inhibitors or histamine blockers.

• Histamine-blockers - Some of the histamine blockers act to block or counter the function of acetylcholine. Acetylcholine in the body causes the release of acid in the stomach. Some histamine blockers like famotidine and cimetidine can help prevent this, thereby reducing the amount of stomach acids that will be released.
• Proton pump inhibitors (PPI)- Proton pump inhibitors are also taken to reduce stomach acids. Your doctor will make the recommendation and also specify how long you have to use the PPIs.

Since factors like diet can worsen or help reduce ulcer symptoms, your doctor may also suggest lifestyle and dietary adjustments you can make to help your stomach heal better and faster. You may also want to discuss some natural stomach ulcer remedies with them.

Wrap up

Stress ulcers can be life-threatening, but when reported early, they can be salvaged.

People often confuse stress ulcers with stomach ulcers because they share similar symptoms. However, intense physical or physiological stress, such as that brought on by a medical condition, is a common cause of stress ulcers.

If you have a long-term health problem and start to show signs of stress ulcers (as discussed in this article), you should see a doctor. Also, keep in mind that although stress is not the primary cause of stomach ulcers, it can contribute to it.