Stress-Induced Gastric Disorders: A Case Study on the Interplay between Stress Hormones and Gastrin Secretion
Patient Background: Sarah, a 35-year-old marketing executive, presented to the gastroenterology clinic with complaints of recurrent epigastric pain, bloating, and heartburn over the past six months. She reported a high-stress job with long working hours and frequent deadlines. Despite dietary modifications and over-the-counter antacids, her symptoms persisted, affecting her quality of life and productivity at work.
Clinical Assessment: Upon examination, Sarah appeared anxious and reported experiencing heightened stress levels due to work-related pressures. Physical examination revealed epigastric tenderness without signs of peritoneal irritation. Laboratory investigations, including complete blood count and liver function tests, were within normal limits. However, an upper gastrointestinal endoscopy revealed mild gastritis with erosions in the gastric mucosa.
Diagnostic Evaluation: Given Sarah’s symptoms and endoscopic findings, further investigations were warranted to assess gastric acid secretion and gastrin levels. A 24-hour ambulatory pH monitoring revealed episodes of acid reflux, consistent with gastroesophageal reflux disease (GERD). Additionally, serum gastrin levels were found to be elevated, suggesting dysregulated gastrin secretion.
Case Analysis: Sarah’s clinical presentation highlights the intricate interplay between stress and gastric physiology. Chronic stress, stemming from her demanding job, triggers the release of cortisol and catecholamines, which influence gastric function. Elevated cortisol levels, observed in individuals experiencing chronic stress, stimulate gastrin secretion, leading to gastric hyperacidity and mucosal injury. Similarly, increased catecholamines directly stimulate gastrin-secreting cells, exacerbating gastric acid secretion and reflux symptoms.
The dysregulated gastrin secretion observed in Sarah contributes to the pathogenesis of GERD and gastritis. Persistent exposure to gastric acid due to impaired mucosal defense mechanisms predisposes individuals to mucosal injury, erosions, and ulcer formation. Furthermore, stress-induced alterations in gastric motility exacerbate GERD symptoms, perpetuating the cycle of mucosal damage and reflux complications.
Treatment Approach: Sarah’s management plan encompassed a multidisciplinary approach targeting both stress reduction and gastric function. Stress management techniques, including relaxation therapy, mindfulness meditation, and regular exercise, were recommended to alleviate work-related stress and mitigate its impact on gastric physiology. Dietary modifications, such as avoiding spicy and acidic foods, and lifestyle interventions, including weight management and smoking cessation, were also emphasized to alleviate GERD symptoms.
Pharmacological interventions aimed at reducing gastric acid secretion and modulating gastrin levels were initiated. Proton pump inhibitors (PPIs) were prescribed to suppress acid production and promote mucosal healing. Additionally, prokinetic agents were administered to improve gastric motility and reduce reflux episodes. Regular follow-up visits were scheduled to monitor symptom resolution, optimize treatment efficacy, and address any ongoing stressors contributing to gastric disturbances.
Outcome: With comprehensive management addressing both stress and gastric function, Sarah experienced significant improvement in her symptoms over the subsequent months. Symptom scores decreased, and she reported enhanced well-being and productivity at work. Repeat upper gastrointestinal endoscopy demonstrated resolution of gastritis, with mucosal healing observed in the gastric mucosa. Serum gastrin levels normalized, reflecting improved regulation of gastric hormone secretion.
Conclusion: Sarah’s case underscores the complex relationship between stress hormones and gastrin secretion in the pathogenesis of stress-induced gastric disorders. A holistic approach encompassing stress management, dietary modifications, and pharmacological interventions is essential for effectively managing these conditions and improving patient outcomes. Further research elucidating the underlying mechanisms and therapeutic targets holds promise for advancing the treatment of stress-related gastrointestinal disturbances.