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Decreased stress resilience in young men significantly increases the risk of subsequent peptic ulcer disease: a prospective study of 233 093 men in Sweden
Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.ORCID iD: 0000-0002-2088-0530
Örebro University, School of Medicine, Örebro University, Sweden.ORCID iD: 0000-0002-0362-0008
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2015 (English)In: Alimentary Pharmacology and Therapeutics, ISSN 0269-2813, E-ISSN 1365-2036, Vol. 41, no 10, 1005-1015 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Psychosocial stress may influence peptic ulcer disease (PUD) risk, but it can be difficult to identify reliably whether stressful exposures pre-dated disease. The association of stress resilience (susceptibility to stress) with subsequent PUD risk has been incompletely investigated.

AIM: To assess if stress resilience in adolescence is associated with subsequent PUD risk.

METHODS: The participants comprised of 233 093 men resident in Sweden, born 1952-1956 and assessed for compulsory military conscription during 1969-1976, with data provided by national Swedish registers. Stress resilience was evaluated through semi-structured interviews by a certified psychologist. Cox regression assessed the association between stress resilience in adolescence and the risk of PUD from 1985 to 2009, between ages 28 and 57 years, with adjustment for parental socioeconomic index, household crowding and number of siblings in childhood, as well as cognitive function and erythrocyte sedimentation rate in adolescence.

RESULTS: In total, 2259 first PUD diagnoses were identified. Lower stress resilience in adolescence is associated with a higher risk of PUD in subsequent adulthood: compared with high resilience, the adjusted hazard ratios (and 95% CI) are 1.84 (1.61-2.10) and 1.23 (1.09-1.38) for low and moderate stress resilience, respectively.

CONCLUSION: Stress may be implicated in the aetiology of PUD and low stress resilience is a marker of risk.

Place, publisher, year, edition, pages
2015. Vol. 41, no 10, 1005-1015 p.
National Category
Gastroenterology and Hepatology
Identifiers
URN: urn:nbn:se:oru:diva-44576DOI: 10.1111/apt.13168ISI: 000353050600009PubMedID: 25809417Scopus ID: 2-s2.0-84927778283OAI: oai:DiVA.org:oru-44576DiVA: diva2:810873
Note

Funding Agencies:

Stiftelsen Olle Engkvist Byggmästare

UK Economic and Social Research Council (ESRC) RES-596-28-0001  ES/JO19119/1

Örebro University

Available from: 2015-05-08 Created: 2015-05-08 Last updated: 2017-10-18Bibliographically approved
In thesis
1. Physical and psychological characteristics in adolescence and risk of gastrointestinal disease in adulthood
Open this publication in new window or tab >>Physical and psychological characteristics in adolescence and risk of gastrointestinal disease in adulthood
2017 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background and objectives: Physical fitness and stress resilience may influence the risk of gastrointestinal (GI) disease. High physical fitness level may reduce levels of systemic inflammation while psychosocial stress exposure can increase inflammation levels and intestinal permeability. The main objectives are to evaluate if poorer physical fitness and stress resilience in adolescence are associated with a raised risk of inflammatory bowel disease (IBD), peptic ulcer disease (PUD) and GI infections in adulthood and to assess evidence of causality.

Materials and methods: Swedish registers provided information on a cohort of approximately 250,000 men who underwent military conscription assessments in late adolescence (1969 –1976) with follow-up until December 2009 (up to age 57 years). Cox regression evaluated the associations of physical fitness and stress resilience in adolescence with subsequent GI disease risk in adulthood.

Results and conclusions: IBD: Poor physical fitness was associated with an increased risk of IBD. The association may be explained (in part) by prodromal disease activity reducing exercise capacity and therefore fitness. Low stress resilience was associated with an increased risk of receiving an IBD diagnosis. Stress may not be an important cause of IBD but may increase the likelihood of conversion from subclinical to symptomatic disease. PUD: Low stress resilience was associated with an increased risk of PUD. This may be explained by a combination of physiological and behavioural mechanisms that increase susceptibility to H. pylori infections and other risk factors. GI infections: Low stress resilience was associated with a reduced risk of GI infections, including enteric infections rather than the hypothesised increased risk.

Place, publisher, year, edition, pages
Örebro: Örebro University, 2017. 74 p.
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 155
Keyword
Physical fitness, stress resilience, adolescence, inflammatory bowel disease, peptic ulcer disease, gastrointestinal infections
National Category
Family Medicine
Identifiers
urn:nbn:se:oru:diva-53959 (URN)978-91-7529-176-5 (ISBN)
Public defence
2017-03-03, Campus USÖ, hörsal C3, Södra Grev Rosengatan 32, Örebro, 13:00 (English)
Opponent
Supervisors
Available from: 2016-12-14 Created: 2016-12-14 Last updated: 2017-10-18Bibliographically approved

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