Long-term symptom patterns in duodenal ulcer: psychosocial factors.
Seventy-five patients with recent-onset dyspepsia and endoscopically visible duodenal ulcer underwent psychological evaluation. Following ranitidine treatment, they were reinterviewed periodically for 12 to 76 months (mean 38.6). Ulcer symptoms were present during a mean of 14.9% of follow-up months. Patients did significantly worse if they had a low-status occupation, low education, depression, stressful life events, or abnormal Minnesota Multiphasic Personality Inventory at baseline. Of patients recalling premorbid life stress, those with a normal MMPI had a particularly benign course, whereas those with an abnormal MMPI did particularly poorly (6% versus 29% of months symptomatic: p < 0.04). Age, gender, smoking, drinking, antiinflammatory drugs, pepsinogen, Helicobacter pylori titers, and initial healing had no prognostic effect. Low socioeconomic status, life stress, depression, and psychopathology each predict a relatively poor symptom outcome for duodenal ulcer treated with antisecretory therapy, but psychologically stable individuals who develop an ulcer under stress have an excellent long-term prognosis.
Levenstein
S
S
Gastroenterology Division, Nuovo Regina Margherita Hospital, Rome, Italy.
Prantera
C
C
Varvo
V
V
Arca
M
M
Scribano
M L
ML
Spinella
S
S
Berto
E
E
D000293:Adolescent; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D004381:Duodenal Ulcer / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016014:Linear Models; D008950:MMPI; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012008:Recurrence; D012307:Risk Factors; D012959:Socioeconomic Factors; D013315:Stress, Psychological; D016896:Treatment Outcome