A stress ulcer is an ulcer of the mucosa of the stomach or duodenum that develops against the background of severe illness or critical conditions. The main manifestation is bleeding from the ulcer, while there is usually no pain. Esophagogastroduodenoscopy is used for diagnosis. The term “stress ulcer” was introduced in 1936 by G. Selie to describe the association between ulcers and severe illness.
Causes of stress ulcer
Stress ulcer develops against the background of severe diseases and critical conditions that disrupt the normal functioning of the body. This can occur with insufficient blood supply to the upper part of the gastrointestinal tract, circulatory problems, blood coagulation disorders, low blood pressure, platelet deficiency, as well as kidney and liver insufficiency. Such ulcers can occur in people after severe trauma, burns, extensive surgeries or in sepsis. If several of these problems are present in the body at once, the risk of developing a stress ulcer increases significantly, and bleeding from the ulcer is very dangerous and predicts an unfavorable outcome.
Stress Ulcer Symptoms
The symptoms of stress ulcers are often hidden and may not be noticeable because of the underlying illness that is causing the patient to be in the hospital. The main difference between these ulcers and other types is that they cause almost no pain. Most often their manifestation is bleeding.
According to statistics, gastroduodenal bleeding from stress ulcers occurs in 25% of patients in intensive care units, and in 5% of them bleeding becomes life-threatening. However, the actual number of such cases may be even higher, because stress ulcers are usually shallow, and bleeding may be latent, not manifesting externally, and detected only by special examination. When bleeding is intense, the following symptoms may appear: severe weakness, pale skin, rapid heartbeat, drop in blood pressure, vomiting blood.
Risk of Stress Ulcer in Different Patient Groups
Certain patient groups are at increased risk of developing stress ulcers. These include:
- Patients in intensive care, especially those with circulatory problems, low blood pressure, or impaired blood clotting.
- Patients after major surgical procedures, including digestive surgeries, and in cases of major trauma and burns that require long-term hospitalization.
- People with diseases affecting the immune system, such as sepsis or immunodeficiency states.
- Patients with severe internal organ disease, especially liver or kidney failure.
- Patients taking long-term anti-inflammatory drugs or corticosteroids, which may increase the risk of gastric mucosal damage and ulcers.
Treatment and supportive therapy
Treatment of stress ulcers requires a comprehensive approach. The main emphasis is on stabilizing the general condition of the patient and controlling the cause that led to the development of the ulcer. Therapeutic measures include:
- Medication: Drugs that reduce the acidity of gastric juice (antacids, proton pump inhibitors) are used, as well as drugs that increase the protective properties of the mucous membrane (for example, sucralfate or misoprostol). H2-histamine blockers, which reduce acid secretion in the stomach, may be used to prevent and treat gastritis and ulcers.
- Nutrition: Early enteral nutrition (feeding through the stomach or intestines) is important to provide the body with all the necessary nutrients to promote ulcer healing. It also helps to maintain the patient’s immune status, preventing exhaustion.
- Circulatory correction: It is important to maintain normal blood pressure, which can be achieved by vasopressors or other means. If hypovolemic shock or hypotension develops, measures are taken to improve hemodynamics, including the use of infusion therapy, plasma substitutes, and blood transfusions.
- Prevention of secondary infections: Given the high likelihood of infectious complications in critically ill patients, it is important to follow infection prevention measures, including antibiotic therapy and the use of medications to prevent hospital-acquired infections.
Surgery
If a stress ulcer causes extensive or persistent bleeding, or if the ulcer progresses despite medical treatment, surgery may be necessary. Surgery involves suturing the ulcer, coagulating the vessels to stop bleeding, or even removing some of the damaged tissue.
Prognosis in stress ulcer
Prognosis depends on the timeliness of ulcer detection and treatment, as well as the patient’s condition. In critically ill patients, the probabilities of outcome can be quite severe. Although stress ulcers rarely result in gastric perforation (rupture of the wall), bleeding remains a major life threat. If bleeding is intense and there is no surgical intervention, the risk of death can be as high as 80%. Thus, early diagnosis, support of vital functions and proper treatment are key factors affecting prognosis.
Effect of Psychological Stress
Psychological stress can also have an effect on ulcer development, although it is not the only factor. Chronic stress can lead to activation of the sympathetic nervous system, which, like physical stress, causes constriction of blood vessels, making it difficult for the gastric mucosal cells to feed normally. Stress can also increase cortisol levels, which depresses the immune system, reducing the body’s ability to fight infections and inflammation.
Relationship of Stress Ulcer and Other Diseases
Stress ulcers can be associated with conditions such as acute pancreatitis, severe infection (sepsis), trauma with disruption of skin and organ integrity, large area burns, major surgery, and diseases requiring long-term use of anti-inflammatory drugs or corticosteroids.
Impact on Long-Term Care and Rehabilitation
Stress ulcers can have significant consequences for long-term patient care and rehabilitation. Patients who survive a stress ulcer with complications such as severe bleeding or surgical intervention may experience prolonged recovery times and additional health challenges. These patients often require extensive monitoring during their rehabilitation process to prevent reoccurrence and address potential complications like infections or organ dysfunction.
Furthermore, managing the underlying critical condition that led to the ulcer is essential to ensure long-term recovery. Psychological factors, such as the stress of the illness, may also affect recovery, necessitating a multidisciplinary approach involving not only medical but also psychological and nutritional support to optimize healing and improve the quality of life. Therefore, comprehensive care is essential for patients recovering from stress ulcers, ensuring both their immediate and long-term health needs are addressed.
Conclusion
Stress ulcer is a serious complication that occurs against the background of severe diseases or critical conditions. Its main manifestation is bleeding, which can be hidden, which requires careful diagnosis and rapid intervention. Treatment includes drug therapy, correction of blood circulation and, if necessary, surgical intervention. Prognosis depends on timely diagnosis and treatment, and early intervention significantly improves outcomes. It is important to consider the high risks in patients with severe conditions to prevent complications and preserve life.
