Does Stress Cause Ulcers? Here’s What Evidence Suggests

The Complex Role of Stress

A common type of ulcer — called a peptic ulcer — forms when stomach acid erodes the protective lining of the stomach or the small intestine, causing sores to develop, said Dr. Carolyn Newberry, a gastroenterologist at NewYork-Presbyterian. Another type, known as a gastric ulcer, forms when the sores develop in the stomach lining specifically.

Researchers estimate that about 5 to 10 percent of people worldwide will develop an ulcer.

Most people with peptic ulcers do not have symptoms, Dr. Mathur said. But some can have upper abdominal pain, upset stomach, heartburn, bloating or nausea. Some ulcers also bleed, causing dark, tar-like stools or stools tinged with bright red blood.

It’s not unreasonable to think that stress could cause ulcers, considering that “stress can definitely cause many gastrointestinal diseases,” Dr. Mathur said, including irritable bowel syndrome, severe acid reflux and inflammatory bowel disease.

But the role of stress in causing ulcers is less clear cut, with some studies suggesting a connection and others not. In a 2015 study of about 3,400 adults, researchers in Denmark found that those who reported the highest levels of stress, compared with those reporting the lowest stress, had 2.2 times higher odds of developing ulcers over the next 11 to 12 years. The researchers noted, however, that about one-third of this excess risk was likely not because of the direct effects of stress, but because of how people reacted to stress — perhaps through smoking or excessive drinking of alcohol, which can each increase ulcer risk.

On the other hand, when researchers analyzed the medical records of nearly 24,000 adults in South Korea who had undergone a procedure called an endoscopy to diagnose ulcers, and gave the patients a test to assess their stress levels, they found that stress was associated with an increased risk for several gastrointestinal conditions, but not ulcers.