PSYCHOLOGIC PREDICTORS OF DUODENAL-ULCER HEALING

We investigated psychologic influences on duodenal ulcer by examining the effect of personality, stress, and mood, measured at diagnosis, on subsequent ulcer healing. Stressful life events, psychopathology (ass essed using the Minnesota Multiphasic Personality Inventory), anxiety, depression, smoking, alcohol consumption, nonsteroidal antiinflammato ry drug use, and serum pepsinogen I levels were determined immediately after endoscopy showed duodenal ulcer craters in 70 patients with rec ent onset of symptoms. Endoscopy was repeated following 6 weeks of ran itidine therapy. Six ulcers (8.6%) persisted, and the duodenum remaine d inflamed in an additional five cases, for a total of 16% with incomp lete healing. The only baseline characteristic significantly associate d with poor healing was anxiety (p = 0.03 for ulcer persistence, p = 0 .02 for incomplete healing). Being in the highest anxiety tertile was associated with a more than fourfold elevation in the risk of incomple te healing (p = 0.02). The association between anxiety and poor healin g was not changed by modification of the anxiety score to eliminate ga strointestinal symptom items or by adjustment for serum pepsinogen, se x, or cigarette smoking. Anxiety inhibits the healing of duodenal ulce rs treated with adequate antisecretory therapy.