Gastric mucosal perfusion and injury: variation in the relationship over time

Acute erosions of the gastric mucosa occur in a variety of clinical settings characterized by a mismatch between mucosal blood supply and demand. Using a canine model incorporating the clinically important insults, we examined the relationship between the gastric mucosal injury measured by planimetry and the animal's regional gastric perfusion measured before, during, and after hemorrhagic shock. The proximal gastric mucosa developed lesions which were inversely related to the amount of gastric flow through 2 hours of shock. In later shock and after reperfusion the relationship reversed, coinciding with the appearance of visible ulcerations. This work demonstrates that early in shock gastric blood flow is inversely related to mucosal injury, but late in shock and after reperfusion increased blood flow is associated with increased mucosal damage.