Stress ulcers are open sores in the lining of your stomach caused by extreme physical stress. They can appear quickly and are often found in critically ill patients.
Stress ulcers are similar to peptic and duodenal ulcers, gastritis and gastropathy, but they differ in several ways. Unlike peptic ulcers, the causes of stress ulceration do not include acid hypersecretion or Helicobacter pylori infection.
Symptoms
Stress ulcers are sores that damage the lining of the stomach or other parts of the digestive tract. They usually develop in people who are already sick from serious health problems like infections, organ failure or head injuries. Unlike regular peptic ulcers, which form gradually over time, stress ulcers usually appear quickly in critically ill patients who are in intensive care units. They can also be much more dangerous because they can cause severe inflammation and bleeding that can complicate existing illnesses.
Symptoms vary, but most commonly include pain in the upper abdomen, upset stomach and nausea. Often, the ulcers will bleed, and people may vomit blood or have stools that look black from the blood. Bleeding can also be a dangerous sign of perforation, a medical emergency that requires immediate treatment.
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Many other conditions can have similar symptoms to ulcers, so it’s important for anyone who thinks they may be suffering from one to get a proper diagnosis from a doctor as soon as possible. Getting the right medication to treat the ulcer can help prevent further complications and reduce symptoms.
The underlying condition and severity of the ulcer determines how the patient will respond to treatment, but any type of stress ulcer can be treated with an antisecretory drug. These drugs, called proton pump inhibitors or H2-receptor antagonists, work by inhibiting acid secretion and promoting healing of ulcers and erosions. They are generally given intravenously, but some doctors choose to give them orally.
Other treatment options for a stress ulcer may include a surgical procedure called a truncal vagotomy. This procedure divides the left and right vagus nerves above the hepatic and celiac branches, which preserves these vital areas. It is a common procedure for severely ill patients with a bleeding stress ulcer.
There is still a lot of research to be done into the role that mental or psychological stress plays in causing ulcers, but the majority of doctors agree that there’s some link. However, it’s also believed that physical stress from an accident or illness can cause the same changes to the body that lead to a peptic ulcer.
Causes
Stress gets a bad rap for many health issues, including stomach ulcers, but it’s not the main culprit. Instead, gastric ulcers are caused by a combination of things such as a common gut bacteria called Helicobacter pylori and overuse of the pain relievers NSAIDs. But that doesn’t mean that stress doesn’t play a role. In fact, it might be an accomplice. The reason: When you’re stressed, your body responds by producing more stomach acid. This can damage the protective lining of the digestive tract and make it vulnerable to ulcers. And the stress also makes you more likely to turn to NSAIDs for relief, which can also fuel ulcer development.
Stress ulcers are different from peptic ulcers, which appear in people who have serious illnesses or injuries such as multiorgan failure, severe infections or head injury. In addition, peptic ulcers tend to develop over time due to H. pylori infection and chronic stress or overuse of NSAIDs.
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But stress ulcers often appear quickly in people who are already seriously ill or injured. And they are more common in patients who are placed on ventilators or admitted to intensive care units.
Like peptic ulcers, stress ulcers may cause sores in the lining of the stomach or duodenum. But these sores are usually much larger, and they may bleed. Bleeding ulcers are a major risk factor for life-threatening complications, such as shock and sepsis.
Moreover, the sores can make it difficult to eat and drink. And they may irritate the airways, which can lead to wheezing and coughing. In extreme cases, ulcers can break through the lining of the stomach or duodenum into the abdomen. This can be very painful and dangerous, because the stomach acids and toxins can enter the bloodstream and poison you.
Although doctors once recommended that people with a history of stomach ulcers eat a bland diet, research now suggests that this is not necessary. Spicy foods do not increase your risk for ulcers, and some studies suggest that NSAIDs may be protective against them.
Treatment
Stress ulcers are open sores in the lining of certain areas of the digestive tract (the series of hollow organs through which food enters the body to be digested). Although they may seem to look similar, stress ulcers differ from peptic ulcers, gastritis, and gastropathy. Unlike these conditions, which can cause pain and discomfort but not damage to the stomach lining, stress ulcers develop when extreme physical stress changes acid levels in your stomach. This can damage the lining of your stomach, called the mucosa.
Stress ulcers most often occur in the stomach, but can also form in the duodenum and esophagus. They can bleed, and when they do, it can be life-threatening. Bleeding ulcers that aren’t treated can lead to a loss of blood in your abdominal cavity and can also cause shock. A severe or perforated ulcer is a medical emergency, as the stomach acids and bacteria that leak from the hole in your gastrointestinal tract can get into your bloodstream and cause a dangerous infection.
Prophylaxis is a way of trying to prevent stress ulcers in people who are at risk for them, including those who spend time in intensive care units. In a study of hospitalized patients, a reduction in stress ulcers was associated with improved respiratory and hemodynamic support. Acid inhibition and an emphasis on adequate nutrition also decreased the incidence of ulcers in these patients.
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In critically ill patients, acid suppression isn’t always possible, as some medications that increase the stomach’s pH interfere with vital organ function. But a proton pump inhibitor such as omeprazole, a medication used for chronic acid-peptic disorders, has been shown to reduce the risk of stress ulcers in critically ill patients. When given orally, omeprazole achieves sufficient acid suppression in less than 24 hours, a finding supported by the use of intermittent monitoring of the stomach’s pH. Omeprazole can be administered by mouth or through a nasogastric tube.
In addition to acid-inhibiting drugs, histamine blockers, such as ranitidine and cimetidine, are also used to prevent stress ulcers. But a Cleveland Clinic Journal of Medicine review cautions that there is no evidence that these medications are helpful in non-critically ill patients, and unnecessary prophylaxis increases costs and the risks of side effects such as infection.
Prevention
While not always avoidable, the risk of stress ulcers can be reduced with certain strategies. The goal is to reduce acid secretion, improve stomach pH, and use antacids to treat symptoms. Historically, doctors also encouraged patients to eat a bland diet but this has been shown to be unnecessary in most cases.
Stress ulcers are open sores that affect the lining of the digestive tract and can be found in various areas including the stomach, duodenum, and distal esophagus. They are more dangerous than traditional peptic ulcers as they may bleed more readily and cause serious complications such as perforation or internal hemorrhage. Stress ulcers can also complicate other conditions that are already present such as infections, organ failure, or head injuries and may lead to increased mortality.
These ulcers are thought to be caused by extreme physical stress resulting in mechanical changes to the gastrointestinal tract including increased gastric secretion, significant decreases in blood flow through the intestine and stomach, and abnormalities of mucosal protection. It was once believed that peptic ulcers (a different type of ulcer) were also caused by psychological stress but this has been proven to be false with the discovery of Helicobacter pylori and its role in peptic ulcer formation.
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The majority of stress ulcers develop in the fundus and body of the stomach. Lesions in these areas tend to occur early in the course of critical illness and are shallow, causing oozing of blood from superficial capillaries. In contrast, ulcers that develop later in the course of critical illness are deeper and can erode into the submucosa leading to massive hemorrhage or even perforation.
Patients that are at high risk for developing stress ulcers include those with major trauma or illness and those who require long hospital stays such as in the intensive care unit or after certain surgical procedures. Prophylaxis with H2 blockers and/or histamine blockers is recommended for these patients.
These drugs are taken as a liquid orally orally or intravenously. Some examples of these medications include cimetidine, ranitidine, and famotidine. It is important to assess each patient’s individual risk for the development of stress ulcers in order to determine if they need to be treated with these medications.
