Stress ulcer: pathophysiology and prevention.

The definition, clinical spectrum and risk factors, incidence, pathophysiology, clinical manifestations and diagnosis, and prevention of stress ulcers are reviewed. Stress ulcers are acute, multiple, superficial ulcerations of the gastric mucosa. All patients who are severely injured or ill may develop stress ulcers. Risk factors include sepsis, shock, multiple organ failure, trauma, burns, and major surgery. Prevention of bleeding from stress ulcers is desirable because medical and surgical treatment of established ulcers is not very effective and has a poor prognosis. Antacids, cimetidine, nutritional support, vitamin A, and corticosteroids have been used. Antacid titration appears to be the method of choice. The preventive value of cimetidine in preventing stress ulcers is controversial.