Prospective studies of gastric secretion in trauma patients.

Patients who had cranial injuries and those who were less severely injured had a normal gastric acid output. Pepsin output decreased throughout the first 72 hours after trauma. Gastric juice protein output was slightly increased. Gastric mucosal cell renewal as estimated by gastric juice DNA was increased. Patients who were more severely injured and those with intra-abdominal trauma had markedly increased gastric acid, pepsin, and protein output after increased gastric mucosal cell exfoliation but a relatively decreased gastric mucosal cell renewal between 36 and 72 hours after trauma. It is concluded that the gastric mucosa must be protected by antacids and/or gastric aspiration before 24 hours after trauma and continued through at least 72 hours. This study supports the importance of acid-pepsin damage during gastric mucosal cell exfoliation and decreased renewal in trauma patients and indicates the timing and value of prophylactic treatment.