A combined regimen for the prophylaxis of Curling's ulcer

After severe thermal injury, acute gastroduodenal mucosal lesions occur in up to 80 per cent of patients. Prior to prophylactic antacid therapy, one-third of these lesions progressed to ulceration, which frequently resulted in major life-threatening hemorrhage. Antacid treatment regimens have dramatically reduced this complication. However, the incidence of occult complications that result in increased morbidity has remained unchanged. We evaluated prospectively a combined treatment regimen using antacid, an H2-receptor antagonist, and enteral feeding in 60 patients who had serious burns (mean burn size, 36% body surface area) in this series. The incidence of both overt and occult complications was 3 per cent and in no patient did a perforation develop nor was operative intervention required. No patient died of the complications of Curling's ulcer. Combination therapy may be of value in other patients prone to stress ulceration.