Abstract

A REVIEW ON STRESS INDUCED ULCER

Lakshmi Krishna*, Sumayya A. R., Prasobh G. R. and Sowmya R. V.

Abstract

Stress induced ulcers may be erosive and ulcerative lesion of the stomach and duodenum that occurs in response to, stressful mental and physical situations in adults and youngsters. Such situations may arise from surgical operations, severe injuries, especially cerebro-cranial trauma, septicemia, during intensive therapy, in persons with respiratory or insufficiency, in cases of carcinoma, in moribund patients; also included, due to the identical symptoms, are ulcers developing during administration of glucocorticoids, salicylates, antirheumatic and anti-phlogistic drugs (pre-disposing factors). The stressinduced peptic ulceration manifests itself in haematemesis, melena, blood within the stools and in perforation. The latter is usually unrecognized due to its asymptomatic and regularly un-dramatic course. Two-thirds of the lesions are within the stomach, predominantly within the sort of multiple haemorrhagic erosions; one-third of the cases are located within the duodenum, almost exclusively within the sort of an acute ulceration; bleeding, thanks to errosion, occurs in an high percentage of those cases. Pathogenetic factors includes shock-induced circulatory disturbances of the gastro-intestinal blood supply with necrosis of the apical mucosal cells, increased gastriointestinal acidity (increased histamine release, vagal stimulation and increased production of glucocorticoids), changes within the mucosal barrier (e.g. gastro-duodenal reflux). Cases of stress-induced peptic ulcers complicating a severe primary disease (which is usually masked by the intestinal symptoms) carry an unfavourable prognosis. With conservative treatment the death rate remains 60 percent; with surgery (neither advisable nor possible in every case) it's 40 percent.

Keywords: Stress; Ulcer; Peptic ulcer disease; Proton pump inhibitors.