Usually, the bacteria is already present, so it appears to be a combination of bacterial presence and acid production, but in most people who develop ulcers, h pylori is a factor. Other causes can be excessive NSAID intake or high alcohol intake (in addition to other irritants), but eradication of the bacteria causes healing in a good number of people with ulcer disease.
H. Pylori
The correlation between "worry" and hyperacidity has long been known.
Some people get headaches, others fatigue, .. and others hyperacidity.
Treatment for ulcers many years ago was to eat foods less likely to stimulate the acid (like baby food) .. later pro banthine and phenobarbital .. then Tagamet .. etc. .. .. all complete with high doses of topical antacid.
The purpose was to cut the production and presence of excess acid-pepsin, end erosion of stomach lining .. and that lead to successful healing.
In cases of ulcer where H. Pylori is present, the reduction in stomach acid caused by the above treatments prevented the H. Pylori-caused inflammation from worsening into acid-pepsin ulcerations. Eventually the immune system dispensed with the H. Pylori. Treatment was about six weeks.
Antibiotics to kill H. Pylori can also irritate the stomach .. regardless, hyperacidity treatments are also prescribed along with the antibiotics, so it's difficult to tell which is the chicken here and which is the egg, as both are being addressed simultaneously.
In cases of ulcer where H. Pylori is not present, the hyperacidity was sufficient in and of itself to eat away at the lining without help from the bacterium to create ulcerated sores.
Most every case of ulcers I've known was associated with a person I knew to be a "worrier", and in other cases I simply didn't know whether the person was a "worrier" or not.
If there is hyperacidity, there is irritation and, perhaps, a munching draw for H. Pylori.
