[Stress ulcer; origin and treatment (author's transl)]

Area of Science:

• Gastroenterology
• Neuroendocrinology
• Pathophysiology

Context:

• Stress and shock are known to trigger complex physiological responses.
• These responses involve the hypothalamic-pituitary-adrenal (HPA) axis and the autonomic nervous system.
• The interplay between these systems can lead to significant gastrointestinal distress.

Purpose:

• To elucidate the pathophysiological mechanisms linking stress, shock, and the development of acute gastric mucosal lesions (AGML).
• To highlight the role of neuroendocrine and autonomic pathways in AGML.
• To emphasize the importance of early diagnosis and prophylactic strategies.

Summary:

• Stress and shock activate the hypothalamus, leading to the release of hormones like ACTH and cortisol, and stimulating the vagus and sympathetic nerves.
• This cascade reduces gastric mucosal blood flow, impairs mucus protection, increases gastric acid secretion, and promotes bile reflux.
• These factors compromise the mucosal barrier, causing histamine release and leading to peptic destruction, resulting in AGML, which are indistinguishable from drug-induced lesions.

Impact:

• AGML share endoscopic characteristics with medicament-induced lesions, necessitating timely emergency endoscopy for diagnosing complications like hemorrhage.
• Prognosis is poor for patients with complicated AGML (e.g., perforation).
• Prophylactic interventions such as vagotomy, nerve blockade, timely fluid resuscitation, antacids, and cholestyramine for bile reflux are vital. Treatment should be guided by endoscopic findings, prioritizing conservative management.