[Stress ulcer; origin and treatment (author's transl)]

Abstract

Conditions like stress and shock influence each other and lead to irritation of the regio hypothalamica not only in its anterior but also in its posterior part with excitement of the n. vagus or the anterior lobe of the hypophysis respectively (ACTH-release with following release of cortisole). Irritation of the n. sympathicus and diminution of the circulating plasma volume are additional sides of the pathophysiological course. Sequels of this are: reduction of blood flow through the gastric mucosa, decrease of the protective ability of the mucus, secretion of an especially aggressive gastric juice and reflux of bile into the stomach. They lead to a breakdown of the mucosa barrier with releasing of histamine in the mucosa, to peptic, destruction of the gastric walls damaged regions and thus to the development of erosions and acute ulcers (AGML=acute gastric mucosal lesions). As to the aspect, these ulcers cannot be differentiated from those lesions of the mucosa which are induced by medicaments. To recognize a complicating hemorrhage in time an emergency endoscopy is recommended. Complicated perforations are seldom observed. Prognosis is bad in patients with complications. Therefore prophylactical measures are of special importance like vagotomy, medicamental blockade of the n. vagus and influencing of the n. sympathicus, infusions in time and in sufficient extent, application of anti-acida and, in case of bile reflux, cholestyramin. Therapy of hemorrhage should be made according to the endoscopical findings. Conservative therapy should be the first aim. If surgical therapy cannot be avoided, methods of minimal risk should be practised.