Indian Write-Ups

A married lady of 26 years was referred to the psychiatry department with acid-peptic disease not responding to conventional treatment with antacids and ranitidine. Aggravation of epigastric pain at night, burning sensation associated with nausea, which waxed and waned during the day, were the chief, complaints during the previous three months. Noteworthy, during physical examination, was mid-line epigastric tenderness. Pulse was 96/min and B. P. slightly elevated at 120/90 mm of Hg. The symptoms had begun gradually with recurrent belching; sleep disturbances, associated with feelings of sadness, hopelessness and palpitations. The psychiatric symptoms appeared to have preceded the epigastric distress symptoms of acid-peptic disease by about two months.

The clinical investigation employing gastroduodenoscopy confirmed the existence of acid peptic disease. On psychiatric examination, no gross psychotic features were seen and higher functions of the central nervous system were well preserved. Anxiety of moderate degree, depressive thoughts and negative thinking were elicited on enquiry.

The social background revealed that this lady was a housewife with a nine-year-old daughter and a seven-year-old son studying in school. Ten years ago, she had lost her eldest child- a male at the age of one year. Her husband was employed as a skilled worker in a factory and was spending a considerable amount of money on alcohol for the last 8-9 years, and as a result, was in debt, which was a source of irritation and shame to the patient.

Secondly, because of this regular, though non-depended drinking, the husband was not able to devote enough attention to the household and to the education of the children. The patient herself had to leave her education incomplete because of financial and other constraints of her parents at her native village, and had to now shoulder the burden of day to day running of household in a city and educate her children.

The diagnosis made by the psychiatry department was adjustment disorder (Depressive type) and Acid Peptic disease. Addition of antidepressant and anti anxiety medication to the anti ulcer regime relieved the patient’s somatic as well as psychological symptoms. Counseling sessions helped in relieving the patient’s anxieties.

PSYCHOSOCIAL FACTORS IN ACID-PEPTIC DISEASE

Peptic ulcer syndrome has long been known to be a "somato-psychic" or "psycho-somatic" disorder. Depending on their early childhood experiences, the patients become hyper-secreter of both acid and pepsin, and even pepsinogen levels are higher in these patients. At the same time, certain emotional factors during adult life can lead to excessive secretion of gastric juices. Anger and frustration on this lady were basically the result of her domestic situation. Though she had come from a village, she was independent minded, but had to seek help in adjusting to the city life in Bombay. She had hardly any time to get adjusted to the city when pregnancy, illness and death of her first born, acted as stresses with which she appeared to have coped adequately.

Subsequent deliveries and bringing up two children without any domestic help and with limited resources tested this intelligent lady’s coping mechanism to the limit. Husband’s indulgence in alcohol distanced him so much from home and spouse, that she could hardly communicate with him. She felt overburdened and had no opportunity to discuss anything with her husband. The pent-up rage and frustration-especially towards the husband-came up during the sessions of psychotherapy. A planned approach to settling of the outstanding debts, husband’s commitment to take greater interest in house-hold problems and the children’s education, and his awareness of the situation which had caused her illness, contributed significantly to relieving the patient’s anxiety.