[Stress-induced peptic ulcer; pathogenesis, clinical features, prevention and treatment (author's transl)]

Stress-induced ulcer is a fairly common acute erosive or ulcerative lesion of the stomach and duodenum that occurs in temporal relationship with, and in response to, stressful physical or mental situations in adults and children. Such situations may arise from surgical operations, severe injuries, especially cerebro-cranial trauma, septicaemia, during intensive therapy, in persons with respiratory or renal insufficiency, in cases of carcinoma, in moribund patients; also included, because of the identical symptoms, are ulcers developing during administration of glucocorticoids, salicylates, anti-rheumatic and anti-phlogistic drugs (pre-disposing factors). The stress-induced peptic ulcer manifests itself in haematemesis, melaena, blood in the stools and in perforation. The latter is often unrecognized because of its asymptomatic and frequently un-dramatic course. Two-thirds of the lesions are in the stomach, predominantly in the form of multiple haemorrhagic erosions; on-third of the cases are located in the duodenum, almost exclusively in the form of an acute ulceration; bleeding, due to arrosion, occurs in an high percentage of these cases. Pathogenetic factors are: shock-induced circulatory disturbances of the gastro-intestinal blood supply with necrosis of the apical mucosal cells, increased gastric acidity (increased histamine release, vagal stimulation and increased production of glucocorticoids), changes in the mucosal barrier (e.g. gastro-duodenal reflux). Cases of stress-induced peptic ulcers complicating a severe primary disease (which is often masked by the intestinal symptoms) carry an unfavourable prognosis. With conservative treatment the mortality rate is still 60 percent; with surgical treatment (neither advisable nor possible in every case) it is 40 percent.