Stress Ulceration What is it? Why is it important?

Stress ulceration is a gastrointestinal mucosal injury related to critical illness.

There is a relationship between GI bleeding and severity of disease.

Likewise there is a strong relationship between bleeding and mortality

Stress ulceration is a gastrointestinal mucosal injury related to critical illness. The ulceration may vary from diffuse superficial injuries to deep hemorrhaging ulcerations. There is a relationship between severity of disease and incidence of ulceration (1) The development of stress ulceration is not related to a history of peptic ulcer disease or Helicobacter infection. The cause, as we will see below, is multifactorial, and related to hypoperfusion and loss of host defenses. The development of clinically significant gastrointestinal ulceration can be devastating to the critically ill patient, representing, as it does, loss of physiological reserve and causing acute hypovolemia and end organ injury. The mortality rate associated with such bleeds is astonishingly high: varying between 48.5% (2) and 87.5% (3).

Like all complications of critical illness, poor patient outcome following gastrointestinal bleeding may reflect underlying severity of illness, rather than importance of the disease process itself. A GI bleed may be a marker of the patient’s condition, rather like a low serum albumin. As the mortality rate for patients admitted to intensive care units is diminishing, so too is the incidence of life threatening gastrointestinal bleeds.

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