Stress ulcer disease in the burned patient

Stress‐induced ulcers of the stomach and duodenum in massively burned patients, otherwise known as Curling's ulcers, result from a defect in the mucosal barrier to secreted acid. The etiology of this defect is related, at least in part, to mucosal ischemia, which is aggravated by hypotension, s...

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Bibliographic Details
Published in:World journal of surgery 1981-03, Vol.5 (2), p.209-220
Main Authors: Pruitt, Basil A., Goodwin, Cleon W.
Format: Article
Language:English
Subjects:
Burns - complications
Cimetidine
Duodenal Ulcer - etiology
Duodenal Ulcer - prevention & control
Duodenal Ulcer - therapy
Humans
Ischemia
Massive Bleeding
Preventive Measure
Secrete Acid
Stomach Ulcer - etiology
Stomach Ulcer - prevention & control
Stomach Ulcer - therapy
Stress, Physiological - complications
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Summary:Stress‐induced ulcers of the stomach and duodenum in massively burned patients, otherwise known as Curling's ulcers, result from a defect in the mucosal barrier to secreted acid. The etiology of this defect is related, at least in part, to mucosal ischemia, which is aggravated by hypotension, sepsis, and hypoxia. Early prophylactic administration of antacids and cimetidine, either singly or in combination, has significantly reduced the occurrence of the life‐threatening complications of these lesions. When preventive measures have failed or have not been utilized and massive bleeding or perforation has occurred, these complications of Curling's ulcer appear to be best treated by gastric resection combined with vagotomy. Résumé Les ulcères de stress qui se développent dans l'estomac et le duodénum des brûlés graves (ulcères de Curling) sont dus à un défaut du mécanisme de défense de la muqueuse contre l'acide secrété. Ce défaut est lui‐même dépendant, en partie en tout cas, de l'ischémie muqueuse qui est aggravée par l'hypotension, l'infection et l'hypoxie. L'administration prophylactique précoce d'antiacides et de cimétidine, seuls ou combinés, a réduit de façon significative la fréquence des complications graves de ces ulcérations. Si les thérapeutiques préventives échouent, ou si elles n'ont pas été utilisées, et si une hémorragie importante ou une perforation survient, le meilleur traitement est la gastrectomie avec vagotomie.
ISSN:0364-2313
1432-2323
DOI:10.1007/BF01658293