[Management of gastrointestinal mucosal damage in patients with cerebrovascular disease]

Cerebro-vascular disorders are often accompanied by gastrointestinal mucosal damages which possibly result in life-threatening massive hemorrhage. Such gastrointestinal complications in acute phase of stroke are usually regarded as one of stress-induced lesions. The pathophysiologic investigation of stress-related gastroduodenal mucosal damages has suggested that increased activity of the autonomic nervous system, in particular sympathetic nervous system, plays an important role in the development of gastric mucosal lesions. The suppression of gastric acid secretion by using H2-receptor antagonists or proton-pump inhibitors is useful for the prevention and management of stroke-induced gastric mucosal damages. In the chronic phase, the drug-induced gastrointestinal mucosal lesions may increase because steroids, non-steroidal anti-inflammatory drugs, anticoagulant and antiplatelet drugs are frequently applied to patients with stroke. The endoscopic interventions such as clipping, infusion of ethanol or epinephrine-contained hyperosmotic saline, and coagulation are effective against gastroduodenal hemorrhage.