Skip to main content
SpringerLink
Log in

Protection against stress-induced acute gastric mucosal injury by free radical scavengers

Intensive Care Medicine volume 17, pages 455–460 (1991)Cite this article

Abstract

This study investigated whether the free radical scavengers allopurinol (50 mg p.o. q.i.d.) and dimethyl sulphoxide (DMSO, 500 mg p.o. q.i.d.) influence the incidence of stress-induced acute gastric mucosal injury in patients with pelvic fractures and hypovolaemic shock. In 177 fully evaluable patients (controln=58, allopurinoln=62, DMSOn=57), endoscopically proven stress-induced injury evolved in a significantly (p<0.01) larger number of controls relative to either group on active therapy. During the first 3 days after hospitalization, 13 controls (22%) developed the injury whereas only 2 patients in each of the allopurinol (3%) and DMSO (4%) groups had this injury. Of these cases, 8 controls (14%) and one patient in the allopurinol group (2%) deteriorated and underwent emergency surgery, however 3 of the controls (5%) died in the immediate post-operative period. The results suggest that oxygen-derived free radicals are directly implicated in stress-induced acute gastric mucosal injury and that removing them protects against this injury and its complications.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 39.95

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Similar content being viewed by others

References

  1. Salim AS (1988) The hypothalamus and gastric mucosal injuries — origin of the stress-induced injury? J Psychiat Res 22:35–42

    PubMed  Google Scholar 

  2. Salim AS (1990) Acute gastric mucosal injuries — origin of the stress-induced injury? A review. Scot Med J 35:3–8

    PubMed  Google Scholar 

  3. Groll A, Simon JB, Wigle RD, Taguchi K, Todd RJ, Depew WT (1986) Cimetidine prophylaxis for gastrointestinal bleeding in an intensive care unit. Gut 27:135–140

    PubMed  Google Scholar 

  4. Holzapfel L, Charreyre S, Aguilera D, Carrere-Debat D, Granier P, Coupry A, Benarbia S, Gontier D (1988) Nosocomial pneumonia in patients given ranitidine. Intensive Care Med [Suppl 2] 14:340

    Google Scholar 

  5. Holzapfel L, Daveau L, Coupry A, Saudin F, Bouletreau P, Carrere-Debat D, Demingeon G, Granier P (1990) Prophylaxis against stress-induced bleeding and nosocomial pneumonia in patients on mechanical ventilation. Intensive Care Med [Suppl 1] 16:S4

    Google Scholar 

  6. Pinilla JC, Oleniuk FH, Reed D, Malik B, Laverty WH (1985) Does antacid prophylaxis prevent upper gastrointestinal bleeding in critically ill patients? Crit Care Med 13:646

    PubMed  Google Scholar 

  7. Laggner AN, Lenz K, Graninger W, Grimmel F, Grimm G, Base W, Schneeweib B, Sertl K (1988) Stressulcus-Prophylaxe auf einer internen Intensivstation: Sucralfate versus Ranitidin. Anaesthesist 37:704–710

    PubMed  Google Scholar 

  8. Kauffman G (1988) Surgical management of stress ulcers. Dig Dis Sci 33:1474

    Google Scholar 

  9. Snyman JH, Wheatley KE; Keighley MRB (1990) Management of non-variceal upper gastrointestinal bleeding. Hosp Update 16:402–417

    Google Scholar 

  10. Harjola PT, Sivula A (1966) Gastric ulceration following experimentally induced hypoxia and hemorrhagic shock: in vivo study of pathogenesis in rabbits. Ann Surg 163:21–28

    PubMed  Google Scholar 

  11. Menguy R, Masters YF (1974) Mechanism of stress ulcer. II. Differences between the antrum, corpus and fundus with respect to the effects of complete ischemia on gastric mucosal energy metabolism. Gastroenterology 66:509–516

    Google Scholar 

  12. Menguy R, Desbaillets L, Masters YF (1974) Mechanism of stress ulcer; influence of hypovolemic shock on energy metabolism in the gastric mucosa. Gastroenterology 66:46–55

    Google Scholar 

  13. Sato N, Kamada T, Shichiri M, Kawano S, Abe H, Hagihara B (1979) Measurement of hemoperfusion and oxygen sufficiency in gastric mucosa in vivo. Evidence of mucosal-hypoxia as the cause of hemorrhagic shock-induced gastric mucosal lesions in rats. Gastroenterology 76:814–819

    Google Scholar 

  14. Salim AS (1987) Reserpine, vagal adrenergic activity and stress-induced acute gastric mucosal injury in the rat. J Physiol 392:363–376

    PubMed  Google Scholar 

  15. Kamada T, Sato N, Kawano S, Fusamoto H, Abe H (1982) Gastric mucosal hemodynamics after thermal or head injury: a clinical applicatiton of reflectance spectrophotometry. Gastroenterology 83:535–540

    PubMed  Google Scholar 

  16. Tryba M (1987) The risk of acute stress bleeding and nosocomial pneumonia in ventilated ICU-patients: sucralfate vs antacids. Am J Med 83(3B):117–124

    PubMed  Google Scholar 

  17. Butterfield JD, McGraw CP (1978) Free radical pathology. Stroke 9:443–445

    PubMed  Google Scholar 

  18. Del Maestro RF, Thaw HH, Bjork J, Planker M, Arfors KE (1980) Free radicals as mediators of tissue injury. Acta Physiol Scand [Suppl] 492:43–57

    Google Scholar 

  19. Itoh M, Guth PH (1985) Role of oxygen-derived free radicals in hemorrhagic shock-induced gastric lesions in the rat. Gastroenterology 88:1162–1167

    Google Scholar 

  20. Salim AS (1989) Role of oxygen-derived free radicals in the mechanism of chronic gastric ulceration in the rat. Implications for cytoprotection. Digestion 43:113–119

    PubMed  Google Scholar 

  21. Salim AS (1990) Role of oxygen-derived free radicals in the mechanism of acute and chronic duodenal ulceration in the rat. Dig Dis Sci 35:73–79

    PubMed  Google Scholar 

  22. Salim AS (1990) The significance of removing oxygen-derived free radicals in the treatment of acute and chronic duodenal ulceration in the rat. J Pharm Pharmacol 42:64–67

    PubMed  Google Scholar 

  23. Mantor PC, Tuggle DW, Perkins TA, Shock CK, Askew AA, Tunell WP (1989) Stress induced gastric ulcers. Curr Surg 46:388–389

    PubMed  Google Scholar 

  24. Parks DA, Bulkley GB, Granger DN, Hamilton SR, McCord JM (1982) Ischemic injury in the cat small intestine: role of superoxide radicals. Gastroenterology 82:9–15

    PubMed  Google Scholar 

  25. Moorhouse PC, Grootveld M, Halliwell B, Quinlan JG, Gutteridge JMC (1987) Allopurinol and oxypurinol are hydroxyl radical scavengers. FEBS Lett 213:23–28

    PubMed  Google Scholar 

  26. Skillman JJ, Silen W (1972) Stress ulcers. Lancet i:1303–1306

    Google Scholar 

  27. Beilke MA, Collins-Lech C, Solnle PG (1987) Effects of dimethyl sulfoxide on the oxidative function of human neutrophils. J Lab Clin Med 110:91–96

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. The Trauma Centre at the Medical City, Baghdad, Iraq

    A. S. Salim

Authors
  1. A. S. Salim
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Salim, A.S. Protection against stress-induced acute gastric mucosal injury by free radical scavengers. Intensive Care Med 17, 455–460 (1991). https://doi.org/10.1007/BF01690766

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF01690766

Key words

search

Navigation