Stress, Gastritis & Peptic Ulcers Disease (PUD)

Perhaps, like me, you’ve grown up knowing stress causes ulcers. Out of curiosity I thought dong a little research would clarify some things because for a long time I never understood how that was possible. In this article, I am going to teach you some really interesting stuff about stress, gastritis and stomach ulcers, otherwise referred to Peptic Ulcer Disease (PUD) in medical jargon.

Figure 1: A stressed man. Source:

Some terms need to be defined before we proceed:

  • Stress- it means feeling troubled or threatened by life.
  • Gastritis- this term refers to inflammation of the mucous membrane lining the wall of the stomach.
  • Peptic ulcer disease- it refers to development of an ulcer or wound in your stomach, usually following unresolved gastritis.

Hang on to learn how unmanaged stress can make you develop stomach ulcers.  You’re also going to learn what you can do to prevent it.

Nobel-Prize-Winning Discovery

Figure 2. A Healthy Stomach and an Ulcerated Stomach. Source:

Many people believe that stress and lifestyle factors are the major causes of peptic ulcer disease. But science says otherwise. In 1984, the Australian Dr. Barry Marshall conducted an interesting experiment on himself.

Before proceeding to drink soup containing cultured H. pylori, Marshall did a biopsy of his stomach to make sure his stomach was clear. Two days later, the Brave and Brilliant Doctor had developed acute gastritis. A week later, a repeat endoscopy was done and the finding was undeniable: Massive gastritis.

After being correctly diagnosed with gastritis, he treated himself with antibiotics. To the chagrin of his staunch critics, his gastritis resolved.

These findings were published in the Australian Medical Journal in the following year1. This discovery rebutted the long-held belief in the medical practice up until then that gastritis and stomach ulcers weren’t caused by bacteria. The reasoning then was that no bacteria was capable of surviving in the acidic environment of the stomach. It was soon clear that the spiral bacteria H. pylori caused more than 90% of duodenal ulcers and close to 80% of gastric ulcers2.

This landmark finding earned Barry Marshall, jointly with his colleague Robbin Warren, the Nobel Prize in Medicine or Physiology in 2005 “for their discovery of the bacterium Helicobacter pylori and its role in gastritis and peptic ulcer disease.3

How Stress Causes Ulcers

An observational study done in Korea between 2007 and 2009 to assess the association between mental health problems and stomach, the researchers found out that extreme psychological stress, having constantly depressed mood and suicidal ideation were associated with PUD4. There are various mechanisms in which this happens:

Figure 3 Gastric Protection: Which one is stronger? Aggressive factor or protective factor? Source:
  1. Your gut is connected to your brain via the arm of the nervous system called autonomic nervous system. This system controls involuntary activities such as digestion and is also involved in fight or flight response when you’re in a tight situation. During stressful situations, there is an over-activation of the autonomic nervous system leads to interference of the brain-gut connection. The outcome is increased secretion of digestive enzymes and stomach acid which induces gastric mucosal injury5.
  2. Psychological stress leads to increased secretion of stress hormone (cortisol) by influencing the hypothalamic-pituitary-adrenal axis. High stress hormone in your blood makes the stomach secrete more acid than is needed5. Increased levels of stress hormones and stomach acid interfere with the normal inflammatory response in the gut thus increasing the susceptibility of mucosal erosion/ulceration.
  3. Depressed individuals are less likely to seek treatment for mild stomach problems such as gastritis or duodenitis (inflammation of the first part of the small intestine, just after the stomach). Their condition can therefore rapidly progress to fully fledged stomach ulcers.
  4. Smoking and alcohol use are social habits more common in people with mental health problems. Smoking promotes production of free radicals or reactive chemicals in the body and induces production of substances that lead to narrowing of blood vessels supplying the stomach which consequently affect mucosal blood flow. Alcohol also disturbs the mucosal barrier by causing the release of vasoactive and inflammatory mediators that cause further injury. Both of these factors tip the balance of mucosal protection equilibrium towards destruction and hence ulcer formation.

Other Causes of PUD

Other than mental stress, there are other factors associated with gastritis and peptic ulcer disease. They include:

  • Certain medications such as aspirin, ibuprofen, naproxen and meloxicam.
  • Alcohol
  • Smoking
  • Caffeinated drinks
  • Overeating
  • Foods that don’t digest easily

What are the Symptoms of Gastritis and PUD?

A common symptom is a burning discomfort felt in the upper abdomen and lower chest, felt as heartburn. It is particularly associated with excessive alcohol intake or eating the wrong foods. Other symptoms include nausea, anorexia (loss of appetite), belching and acid reflux.

Prevention and Self-Help

Learn better and healthy ways of managing stress and coping with adversity. Examine your lifestyle and whether you abuse your stomach through excessive drinking, improper eating especially fast foods or foods that irritate your stomach. Hot, fatty and spicy foods tend to induce gastritis. Avoid taking excessive painkillers or NSAIDs mentioned earlier. Cut down on caffeine preparations and avoid or stop smoking if you do smoke.

When to See a Doctor

  • Persistent symptoms
  • Prolonged vomiting
  • Very severe pain
  • Signs of dehydration such as excessive thirst and scanty urination
  • Vomiting blood or ‘coffee grounds’-type vomitus
  • Black or tarry bowel movements


  1. Marshall BJ, Armstrong JA, McGechie DB, Glancy RJ. Attempt To Fulfill Koch’s Postulates For Pyloric Campylobacter. Medical J Australia. 1985;142:436–439
  2. Ahmed N. 23 Years Of The Discovery Of Helicobacter Pylori: Is The Debate Over? Ann Clin Microbiol Antimicrob. 2005;4:17. Published 2005 Oct 31. doi:10.1186/1476-0711-4-17
  3. The Nobel Prize in Physiology or Medicine 2005. Nobel Prize Outreach AB 2022. Mon. 22 Aug 2022. <>
  4. Lee, Young Bok The Association Between Peptic Ulcer Diseases and Mental Health Problems, Medicine: August 2017 – Volume 96 – Issue 34 – p e7828 doi: 10.1097/MD.0000000000007828
  5. Di Mario F, Goni E. Gastric Acid Secretion: Changes During a Century. Best Pract Res Clin Gastroenterol. 2014 Dec;28(6):953-65. doi: 10.1016/j.bpg.2014.10.006. Epub 2014 Oct 30. PMID: 25439063.

Article written by Cedric Ambenje, a Medical Student from Jomo Kenyatta University of Agriculture and Technology (JKUAT).

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