Stress ulcers.

Gastric stress ulceration occurs rapidly in patients after severe trauma. However, bleeding from stress ulceration is a rare but very serious complication after trauma and major surgery. Important risk factors for stress ulcer bleeding are shock, especially septic shock, and the development of other components of the multiple system organ failure syndrome. The pathophysiology and treatment of stress ulceration is reviewed in this paper. Prophylaxis is the best form of treatment, and the most effective prophylaxis is optimal resuscitation and intensive care. In addition, pharmacologic prophylaxis, including antacids, sucralfate, or acid secretory inhibitors, has been advocated. Once profuse bleeding has started, measures other than aggressive treatment of shock and sepsis are usually unsuccessful.