Stress ulcers - Cushing ulcers: diagnosis, treatment, prevention

BACKGROUND: Cushing ulcers appear at the 3rd to 5th day after stress situations accompanied with hemorrhage in 5-10%, perforations in 4%. METHODS: Between 2007-2011 in the National Scientific and Practical Center for Emergency Medicine Kishinev, 1917 patients with superior gastric hemorrhages were treated, from which 139 in ICU. RESULTS: In 45 cases were diagnosed Cushing ulcers: men – 30, women – 15 with age between 21 years and 87 years. The disease causes were: cerebral vascular diseases 13(28.8%); fractures with hip replacement – 16 (35.5%); chronic renal insufficiency and septic states - 3 (12.32%); severe head trauma – 10 (22.2%). The mortality rate was 22.2% (10 patients). Gastroscopy revealed hemorrhages followed by endoscopic hemostasis. For the prophylaxis of hemorrhage relapse all patients underwent repeated endoscopic hemostasis 2 to 3 times. One patient was operated for a perforated bulbar Cushing ulcer and another one due to Forrest IA hemorrhage that didn’t respond to endoscopic hemostasis – Bilroth I antrum resection. Both patients died due to multiple organ dysfunction syndrome (MODS). Patients with Cushing ulcers received anti-ulcer treatment: PPI, H2 blockers in maximum dosages, hemostatic and repeated blood plasma transfusions. CONCLUSIONS: Gastroscopy is obligatory in all patients with severe head trauma, septic states, chronic renal insufficiency and severe cerebral vascular diseases. Anti-ulcer and hemostatic treatment insures ulcer healing and scarring in most of the cases.