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World Journal of Surgery

, Volume 5, Issue 2, pp 165–172 | Cite as

The pathophysiology of stress ulcer disease

  • William Silen
  • Aryeh Merhav
  • Jay N. L. Simson
Article

Abstract

Stress ulcers are superficial mucosal lesions located predominantly in the fundus of the stomach. They occur mainly in the victims of severe trauma and sepsis and are to be clearly distinguished from Cushing's ulcers, ulcers induced by drugs and from activation of a preexistent ulcer. It is generally agreed that mucosal ischemia is the major inciting event in the pathogenesis of acute stress ulceration of the stomach and that the presence of luminal acid and pepsin are required for overt ulceration to develop. Back-diffusion of acid occurs in the absence of overt disruption of the gastric mucosal barrier, is closely related to the formation of ulcers, and may be enhanced by reflux of duodenal content into the stomach and by diffusion of blood urea into the stomach. Severe acidosis and base deficit together with depression of acid secretion and consequent lowering of alkaline tide are important contributing factors. A differential energy deficit in fundic mucosa as a result of ischemia probably contributes to mucosa damage by interfering with anion exchange (HCO 3 for Cl). The exact role of steroids and prostaglandins is controversial.

Keywords

Prostaglandines Mucosal Barrier Stress Ulcer Base Deficit Important Contribute Factor 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Résumé

Les ulcères de stress sont des lésions muqueuses superficielles localisées de préférence dans le fundus gastrique. Elles surviennent surtout chez les traumatisés graves et dans les infections sévères. Elles sont différentes des ulcères de Cushing, produits par les médicaments ou par activation d'un ulcère pré-existant. On admet en général que l'ischémie muqueuse est le facteur pathogène le plus important des ulcérations aiguës de stress et qu'il faut de l'acide et de la pepsine dans la lumière gastrique pour que l'ulcération se forme. Il se produit, même en l'absence d'une rupture franche de la barrière muqueuse, une rétrodiffusion d'acide. Elle est en rapport direct avec l'apparition des ulcérations. Elle peut être favorisée par le reflux du contenu duodénal et par diffusion de l'urée sanguine dans l'estomac. L'acidose grave, le déficit de base, la dépression de la sécrétion d'acide avec réduction de l'onde alcaline jouent un rôle pathogène important. Il est probable qu'un déficit énergétique au niveau de la muqueuse fundique, résultat de l'ischémie, participe à l'apparition des lésions muqueuses en perturbant les échanges d'anions (HCO3 et C1). Le rôle exact des stéroïdes et des prostaglandines est controversé.

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Copyright information

© Société Internationale de Chirurgie 1981

Authors and Affiliations

  • William Silen
    • 1
  • Aryeh Merhav
    • 1
  • Jay N. L. Simson
    • 1
  1. 1.Departments of SurgeryHarvard Medical School and Beth Israel HospitalBostonUSA

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