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Bellyaching in These Pages: Upper Gastrointestinal Disorders in Psychosomatic Medicine

From San Camillo-Forlanini Hospital, Rome, Italy.

Address reprint requests to: Susan Levenstein, MD, Via del Tempio 1A, 00186 Rome, Italy. Email: slevenstein{at}compuserve.com

ABSTRACT

OBJECTIVE: The evolution of views regarding the impact of psychosocial factors on peptic ulcer was traced by examining all articles related to the upper gastrointestinal tract published in Psychosomatic Medicine since its inception.

METHODS: Titles were retrieved using MEDLINE and by manually searching tables of contents for the years 1939 through 2000. The articles were classified by type and reviewed for gastrointestinal topic, broad biopsychosocial themes, methodology, and hypotheses.

RESULTS: One hundred seven articles were found, peaking in the 1960s. Of these, 73.8% reported large-sample research, 10.3% were case reports or series (all before 1965), and 15.9% were review articles or commentaries (most frequent before 1950 and after 1990). The chief topic was peptic ulcer in 47.7%, ulcer related in 29.9%, nonulcer dyspepsia or motility in 15.0% (dominating research since 1990), and miscellaneous in 7.5%. Original investigations related to peptic ulcer dropped off steadily after 1970. Attention was consistently paid to interactions of psychological factors with gastric acid secretion but not with several other important ulcer risk factors: Helicobacter pylori, smoking, and nonsteroidal antiinflammatory drugs. Interest in personality, stress, and laboratory methodology remained steady over time, whereas psychoanalysis and the specificity hypothesis declined, and statistical comparisons and quantitative approaches to psychological assessment rose.

CONCLUSIONS: Psychosomatic Medicine articles reflect the life history of the stress-acid theory of peptic ulcer: hypothesis generation through case studies; a boom of experimental research; and retrenchment into literature reviews with a falloff in original investigations when new views of etiology and effective medical therapies appeared.

Key Words: peptic ulcer, • stress, • stomach, • duodenum, • dyspepsia, • history of medicine.

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