A stress ulcer is acute damage to the mucosa of the stomach or duodenum that occurs as part of a stress response.
Stress ulcers in neurosurgery
The risk of stress ulcers in critically ill patients with CNS pathologies is high1. CNS risk factors include the following intracranial pathologies2:
- Patients with traumatic brain injury (particularly patients with GCS < 9).
- Brain tumors
- Intracerebral hemorrhages
- SIADH
- CNS infections
- Ischemic strokes
- Injuries to the spinal cord
The risk of stress ulcers is increased in these patients, particularly when long-term steroid therapy is also present3. The pathophysiology of the CNS component is not fully understood. It is assumed that CNS pathology involving the diencephalon and brainstem leads to a reduction in vagal output, consequently resulting in hypersecretion of gastric acid and pepsin. For example, there is a peak in pepsin and gastric acid production 3-5 days after a CNS injury4.
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