[Gastroduodenal stress lesions and hemorrhages--pathogenesis, diagnosis, prevention and therapy]

Following a short summary of the historical development of the terminology, the nosological separation between peptic ulcer disease and secondary ulcers including the gastroduodenal stress erosions and ulcers - is stressed. The differing and in the last 20 years decreasing frequency of the different causes as well as the pathogenesis - mainly disturbances of the mucosal defense mechanisms (blood supply, mucus secretion and epithelial renewal) - are discussed, partly referring to results of own investigation. The diagnosis implies - depending on the state of the patient - an emergency esophagogastroduodenocopy after the treatment of shock. The different outcome of bleeding in common peptic ulcer and in stress lesions is analyzed in detail as well as the limiting risk factors. The decrease of the incidence and the improvement of prognosis under a modern interdisciplinary intensive care of acutely ill patients, especially due to a strict shock therapy are stressed. The interventional-local therapy of stress-induced gastric or duodenal bleeding is not practicable, debatable, if performed with drugs, and surgically not possible; however, this dilemma is as mentioned above due to the less frequent occurrence of such a situation considerably diminished. The major effort of prophylaxis of gastroduodenal stress lesions is clearly directed towards an influence of causes and risks; several drugs - mainly H2 blocking agents, sucralfate and antacids demonstrate a comparable efficacy. The potential risk of a nosocomial pneumonia is differently seen; undebatable trials demonstrating a clear superiority of either prophylactically applied drugs do not exist.