Can College Students Get Ulcers?

"Does STRESS cause stomach ulcers?"

In a college health center, this is a question I hear fairly often, especially around midterms or finals. Certainly most of us have experienced stomach discomfort when we are anxious- whether that is nausea, cramping, diarrhea or pain- but the vast majority of people with those symptoms do not have actual ulcers.

However, people who are stressed may have COPING HABITS that can irritate the stomach lining, causing a gastritis (inflammation of the stomach lining) which might facilitate the development of ulcers:

• Drinking too much alcohol (more than one drink/day for women, or more than 2 drinks/day for men) 
• Using too many NSAIDs (Non Steroid Anti Inflammatory Drugs) like ibuprofen (aka. Advil/Motrin/etc).

Of course, college football weekends with prolonged tailgating and subsequent hangovers (treated with ibuprofen) are the perfect set up before "stress" from midterms is even a factor.

Stomach ulcers, meaning an abrasion or "ulceration" in the inside lining of your stomach, are actually primarily caused by a bacteria called H. pylori, which lives in the GI tracts of approximately 30-40% of Americans. It may be present for decades before it causes any symptoms. This bacteria is identified within 70-95% of ulcers that are biopsied in the stomach and the first part of the small intestine, the duodenum.

What are symptoms of stomach ulcers?
The discomfort of ulcers starts off feeling like hunger to many people- a deep ache, located below your breastbone and above your belly button. The pains may come and go at first, and may also be associated with feeling nauseated or bloated after meals. Initially, taking an antacid such as TUMS will relieve this sensation. The timing of the pains tends to vary with the location of the ulcer, and the pains might come and go for weeks at a time.

How does a doctor check for ulcers?
For young people (under 55 years) who are otherwise healthy, the current standard of care is to test for the presence of H. pylori bacteria, and treat immediately if that is positive. There are blood tests, breath tests and stool tests available. For older patients or those with risk factors for stomach cancer, direct visualization with endoscopy is recommended to allow the doctor to biopsy any suspicious areas.

How are ulcers treated?
If your doctor finds H.pylori, you will be treated with not one, but several medications: one acid blocking medication called a proton pump inhibitor, and two antibiotics. There are different regimens, but all include at least these medications at different dosages and timing.

If it's not an ulcer, what else could it be?
Persistent, recurrent upper abdominal pain and nausea could multiple other medical issues, including (but not limited to) gall stones, pancreatitis, hernias, colon disease (including celiac or inflammatory diseases like Crohn's) or other systemic illness. The key point here is not to worry you, but to encourage you not to suffer in silence. Avoid the temptation to self-diagnose or to try every over-the-counter remedy before heading in to see your family physician.

BOTTOM LINE: If you are having recurrent pain in your upper abdomen, nausea, bloating or other discomfort, stop taking NSAIDS and drinking alcohol, and head in to see your doctor.