Many people associate stomach ulcers with emotional stress. But while you can get a stress ulcer, the cause isn't emotional. "You can't worry yourself into an ulcer," says Brooks Cash, MD, chief of gastroenterology at the University of Texas Health Science Center at Houston.
"Emotional stress, even severe emotional stress, does not cause any type of ulcer," explains Dr. Cash. "The term 'stress ulcer' is often confused with other ulcer terms like 'peptic ulcer,' 'gastric ulcer' and 'duodenal ulcer.' Peptic ulcers are ulcers of the upper digestive tract, and they include ulcers in your stomach, called gastric ulcers, and ulcers in the beginning of your small intestine, called duodenal ulcers."
The Differences Between Ulcers
Peptic ulcers are most often caused by an infection from the common bacteria called Helicobacter pylori or from taking too many nonsteroidal anti-inflammatory drugs (NSAIDs) like aspirin, ibuprofen (Advil or Motrin) and naproxen (Aleve), says the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).
"The cause of stress ulcers is different," says Dr. Cash. "When doctors talk about stress ulcers, we are referring to physiologic stress. This is the type of stress caused by being very ill. Examples include being on a respirator in the intensive care unit, having severe burns or having an infection that has spread to your blood stream, called sepsis."
To protect your stomach and duodenum from acid, you need a healthy, protective layer of mucous as a barrier. "People under severe physical stress do not maintain a sufficient perfusion with blood and stimulation with food to maintain this barrier," explains Dr. Cash.
Stress ulcers are dangerous because they can eat away at the surface of the upper digestive system and cause bleeding, explains a March 2014 review in the journal Critical Care.
Read more: How to Exercise With an Ulcer
Stress Ulcer Symptoms
NIDDK says the main symptom of a peptic ulcer is epigastric pain, which is pain underneath your breastbone. By contrast, the main sign of a stress ulcer is bleeding, the Critical Care article points out.
Stress ulcers are a type of "erosive gastritis," says Merck Manual, and may also be called stress-induced gastritis or gastropathy, or stress-related mucosal disease or damage, according to the U.S. National Library of Medicine as well as numerous published studies on the topic, including the Critical Care study.
Bleeding with this type of ulcer tends to start slowly and, therefore, people may not have any symptoms, or they may notice that their stool is black due because blood has passed through their digestive system, states Merck Manual. In cases where bleeding is rapid, a person may vomit blood or pass blood in their stool, it adds.
Doctors are aware of the danger of stress ulcers in very sick people and will usually treat these patients preemptively with medications to coat the stomach and duodenum and to reduce the amount of acid produced in the stomach in an effort to prevent stress ulcers from forming. These ulcers are relatively uncommon, according to a 2015 study published in Nature Reviews, but they can be deadly.
"Treatment for patients who develop a bleeding stress ulcer may involve placing a flexible fiberoptic camera into the esophagus, stomach and small intestine," explains Dr. Cash. "This test is called an esophagogastroduodenoscopy (EGD), and doctors can stop bleeding with a variety of techniques during an EGD." Severe bleeding, though, may require a blood transfusion," he says.
Read more: Foods to Avoid When You Have a Stomach Ulcer
What About Emotional Stress?
Emotional stress can, in fact, cause some digestive symptoms, according to the Canadian Society of Intestinal Research.
You've probably experienced the sensation of your stomach churning or feeling slightly sick to your stomach when having a really bad day at work or school. Emotional stress may delay emptying of your stomach or increase movement of fluids and food through your intestines, possibly causing a bout of diarrhea, says the Canadian Society.
Though emotional stress can't cause an ulcer, if you have a peptic ulcer, it can make your symptoms seem worse, it adds. That's because stress can lower your threshold for any type of pain.
Finally, as the Canadian Society points out, you could trigger or ramp up your ulcer pain if you give in to stress by smoking or drinking alcohol. Alcohol irritates an ulcer, and smoking can increase your susceptibility to H. pylori infection and even increase the amount of acid produced in your stomach.
Is This an Emergency?
- American College of Gastroenterology: “Peptic Ulcer Disease”
- Canadian Society of Intestinal Research: “Stress and Your Gut”
- Canadian Society of Intestinal Research: “Smoking and the Digestive Tract”
- Nature Reviews Gastroenterology & Hepatology: “Stress-Related Mucosal Disease in the Critically Ill Patient”
- National Institute of Diabetes and Digestive and Kidney Diseases:"Definition and Facts for Peptic Ulcers (Stomach Ulcers)"
- Critical Care: "Stress Ulceration: Prevalence, Pathology and Association with Adverse Outcomes"
- NIDDK: "Symptoms and Causes of Peptic Ulcers (Stomach Ulcers)"
- Merck Manual: "Gastritis"
- U.S. National Library of Medicine/StatPearls: "Stress-Induced Gastritis"