Stress ulcers are areas of irritation on the lining of the stomach and/or duodenum (the first part of the small intestine attached to the stomach) that have been eroded or eaten away by gastric acids or juices. Their name reflects not the everyday stress of 21st century life but rather the physiologic stress caused by trauma, serious illness or severe burns elsewhere on the body.
The two main types of stress ulcers are Cushing’s and Curling’s ulcers, each of which is related to specific types of physiologic stress. Cushing’s ulcer is generally seen in the lining of the stomach and is rarely found in the duodenum, while the reverse is true of Curling’s ulcer. Cushing’s, according to an article in the April 2008 issue of the Chinese Journal of Traumatology, most often is diagnosed in patients who have had some sort of traumatic brain injury. Curling’s is seen most often in people who have suffered “burns, intracranial lesions or severe bodily injury,” according to Mosby’s Medical Dictionary.
Stress ulcers, particularly in their early stages, can be asymptomatic. However, as the extent of ulceration grows, the symptoms will be similar to those experienced by people with regular peptic ulcers. Those symptoms may include a burning pain that comes and goes, loss of appetite, blood in the stool and vomiting of blood. Unlike a peptic ulcer, a stress ulcer is less likely to show a definite pattern of reaction to food. Whereas eating usually eases the pain of a regular peptic ulcer, it will not necessarily do so in a stress ulcer.
Because stress ulcers are caused by physiologic stress from traumatic injury or serious illness, it is important for physicians to take steps to protect their patients from the threat of this added complication. In many cases, patients may be in no position to protect themselves against stress ulcers because of the severity of their injury or illness.
Although stress ulcers almost always occur in patients who have suffered serious illness or a severe injury, the actual mechanism causing those ulcers has not been conclusively pinpointed. However, writing in the October 2004 issue of Critical Care Medicine, Ryan J. Daley said that a poll of critical care physicians revealed that roughly 60 percent of them believe ischemia--an insufficient flow of blood--to the GI system was the main cause of stress ulcers.
Acid suppression therapy is the treatment of choice for those at risk of stress ulcers. In an article written for Pharmacy Times, Antony Q. Pham, a surgery/transplant clinical pharmacist at Ronald Reagan UCLA Medical Center in Los Angeles, reported acid-suppressing medications have brought about a sharp reduction in the incidence of bleeding as a consequence of stress ulcers. Pham said the risk of such bleeds had dropped from roughly 20 to 30 percent 25 years ago to 2 to 14 percent today.