[Stress ulcer: clinical aspects, pathogenesis, diagnosis and therapy]

The frequency, the treatment and the mortality of stress induced ulcers and erosions of the upper alimentary tract are surveyed. The experimental data concerning such ulcers and erosions are reported. Most important is the local mucosal ischaemia with a concomitant reabsorption of H-ions. Intravasal coagulation processes and a local diminution of the Vitamin A content may be additional factors. 37 stress induced bleedings observed in 460 patients of a surgical intensive care unit are analysed. The mortality of the conservatively treated group was 60% and higher than the mortality after operative treatment (42%). The high mortality was due to the associated states of shock, hypoxaemia and sepsis. A prospective study comporting 50 patients of a medical intensive care unit shows the little importance of intravasal coagulation for gastrointestinal bleedings during septicaemia. The possible influence of psychological factors for the induction of stress induced bleedings was analysed on 112 tetraplegics and paraplegics, all under the same conservative treatment comporting high doses of Dexamethason. The frequency of gastrointestinal bleedings was very high in complete traumatic tetraplegia (41%), smaller in complete traumatic paraplegia (16%), much lower in incomplete traumatic and complete non-traumatic lesions.