Cushing’s and Curling’s Ulcer
Stress-related mucosal disease; Stress ulcer
Cushing’s ulcer is considered a stress ulcer, a condition that results from an imbalance between gastric protection and gastric acid production in response to a major insult (traumatic brain injury in the case of Cushing’s ulcer). Harvey Cushing published in 1932 a paper with the description of patients who postoperatively and unexpectedly died of perforated peptic ulcers. It was one of the first descriptions of a stress ulcer and a treatise on the brain-stomach connection. The lesions arise from the action of the parasympathetic centers of the hypothalamus and their connections to vagal nuclei in the medulla increasing gastric acid production. The pathogenesis includes the disequilibrium between major destructive factors like acid and pepsin and the protective factors like mucosal blood flow, mucous bicarbonate layer, epithelial renewal, and prostaglandin production. On the other side, in 1842, Curling reported 12 cases...