Kuo, Chien-Feng, Shi, Leiyu, Lin, Cheng-Li et al. · Scientific reports · 2021 · DOI
This study looked at whether people who have had peptic ulcers (stomach ulcers often caused by H. pylori bacteria) are at higher risk of developing ME/CFS. Researchers compared hospital records from Taiwan for people with and without peptic ulcers over many years. They found that people with a history of peptic ulcers were about twice as likely to develop ME/CFS, with higher risk in women and older adults.
Understanding potential infectious or inflammatory triggers for ME/CFS is critical for prevention and early intervention strategies. This large population-based study suggests that screening and treating peptic ulcer disease, particularly H. pylori infection, may help reduce the risk of developing ME/CFS, especially in vulnerable populations.
This study demonstrates association, not causation—it does not prove that peptic ulcers cause ME/CFS. The findings cannot establish the biological mechanism linking PUD to CFS development. Additionally, reliance on claims data means CFS diagnoses were not clinically validated according to current research case definitions, which may affect the strength of conclusions.
About the PEM badge: “PEM required” means post-exertional malaise was an explicit required diagnostic criterion for participant inclusion in this study — not that PEM was studied, observed, or discussed. Studies using criteria that do not require PEM (e.g. Fukuda, Oxford) are tagged “PEM not required”. How the atlas works →
The first block is for the primary paper and is the citation you should use in research work. The atlas-snapshot line only applies if you are specifically referring to this atlas’s reading of the paper on the date shown.
Primary citation
Kuo, Chien-Feng, Shi, Leiyu, Lin, Cheng-Li, Yao, Wei-Cheng, Chen, Hsiang-Ting, Lio, Chon-Fu, et al. (2021). How peptic ulcer disease could potentially lead to the lifelong, debilitating effects of chronic fatigue syndrome: an insight.. Scientific reports. https://doi.org/10.1038/s41598-021-87018-z
BibTeX
@article{mecfsatlas-kuo-2021-how-peptic,
author = {Kuo, Chien-Feng and Shi, Leiyu and Lin, Cheng-Li and Yao, Wei-Cheng and Chen, Hsiang-Ting and Lio, Chon-Fu and Wang, Yu-Ting Tina and Su, Ching-Huang and Hsu, Nai-Wei and Tsai, Shin-Yi},
title = {How peptic ulcer disease could potentially lead to the lifelong, debilitating effects of chronic fatigue syndrome: an insight.},
journal = {Scientific reports},
year = {2021},
doi = {10.1038/s41598-021-87018-z},
note = {PubMed: 33824394},
url = {https://www.mecfsatlas.com/evidence/kuo-2021-how-peptic},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-30. https://www.mecfsatlas.com/evidence/kuo-2021-how-peptic
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