Abstract
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.
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The opinions or assertions contained herein are the private view of the authors and are not to be construed as official or as reflecting the views of the Department of the Army or the Department of Defense.
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Pruitt, B.A., Goodwin, C.W. Stress ulcer disease in the burned patient. World J. Surg. 5, 209–220 (1981). https://doi.org/10.1007/BF01658293
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DOI: https://doi.org/10.1007/BF01658293