Novel Data Analyses Explain the Seasonal Variation of Peptic Ulcers

Abstract

Although 13 etiological theories, including the most recent Theory of Helicobacter pylori, have been proposed to explain the pathogenesis of peptic ulcers, the seasonal variation of the disease has remained an unsolved mystery for ≥90 years. Additionally, the major characteristics and observations/phenomena of peptic ulcers have never been fully understood. To address these challenges, a recently published Complex Causal Relationship with its accompanying methodologies was applied to analyze the existing data. Peptic ulcers were identified as a psychosomatic disease triggered by psychological stress, where Helicobacter pylori plays a secondary role in only the late phase of ulceration. This etiology addresses all the characteristics, observations/phenomena, controversies, and mysteries of peptic ulcers in a series of 6 articles. This fourth article focuses exclusively on the seasonal variation of peptic ulcers. The seasonal changes on the earth periodically alter multiple environmental/social factors, each of which induces psychological stress in a proportion of individuals and result in a monthly incidence of peptic ulcers. The superposition of the monthly incidences caused by climate, work, and vacation reproduces 3 typical fluctuation curves of the seasonal variation. Further discussion suggests that surrounding psychological stress, multiple environmental and social factors, such as tradition, climate, industry, vacation, and well-being policies, work together to cause the diversity of the seasonal variation. A full understanding of the seasonal variation suggests that peptic ulcers are not an infectious disease caused by Helicobacter pylori, but a psychosocial disease associated with multiple environmental/social factors, further validating the etiology identified by the Complex Causal Relationship.

Novel Data Analyses Address the African Enigma and Controversies Surrounding the Roles of <i>Helicobacter pylori</i> in Peptic Ulcers <strong> </strong>

“…In contrast, Theory of Nodes explained all three epidemiological observations based on 'peptic ulcers are a psychosomatic disease triggered by psychological stress, where Helicobacter pylori plays a secondary role in only the late phase of ulceration', and verified Susser and Stein's speculation that the mortality rates of peptic ulcers were associated with World War I and the unemployment of the 1930s [30]. It is the psychological stress induced by seasonal changes that account for the seasonal variation of peptic ulcers [31]. Interestingly, the mechanism of the birth-cohort phenomenon presented herein is also applicable to understanding the African enigma: it is not the prevalence of H. pylori, but the diverse living environment, political environment, social welfare, conflicts, etc.…”

“…Thus, H. pylori infection does not account for the seasonal variation of the disease. In Theory of Nodes, the seasonal variation of peptic ulcers is caused by the fluctuation of psychological stress in the population induced by the seasonal changes on the earth [31], and this theory also elucidated all the other epidemiological observations of peptic ulcers, including the birth-cohort phenomenon.…”

“…Theory of H. Pylori [11] Theory of Nodes [27][28][29][30][31] 15 characteristics [6] None of the 15 can be explained All the 15 are explained Etiology Peptic ulcers are an infectious disease caused by the infection of H. pylori [11].…”

“…All explained [27][28][29][30][31] Addressed: H. pylori is not an etiological factor but plays a secondary role in only the late phase of ulceration [27][28][29]. Roles of gastric acid Unknown [12,111] Addressed [27,28].…”

“…Encouragingly, this etiology can explain all the 15 characteristics and 81 observations/phenomena of peptic ulcers [29]. This etiology also fully addresses all the controversies and mysteries associated with peptic ulcers, such as the birth-cohort phenomenon [30] and seasonal variation [31] of peptic ulcers, and the morphology of gastric ulcers [28], as well as the roles of gastric acid, H. pylori, and NSAIDs in the disease [27,28]. The similarities and differences between duodenal and gastric ulcers are also clarified [28].…”