II. Causes

  1. Medications
    1. Aspirin
    2. NSAIDs
    3. Alcohol
  2. Severe stress (mucosal protection breaks down, allows for splanchnic hypoperfusion)
    1. Burns
    2. Sepsis
    3. Trauma
    4. Surgery
    5. Shock
    6. Respiratory failure
    7. Renal Failure
    8. Liver failure
    9. Mechanical Ventilation

III. Symptoms (May be asymptomatic)

  1. Epigastric discomfort
  2. Nausea or Vomiting
  3. Hematemesis
  4. Melena

IV. Signs

  1. Epigastric tenderness

V. Diagnosis

  1. Upper endoscopy (EGD)
    1. Mucosal inflammation and engorgement
    2. Erosions and Hemorrhages
  2. Upper GI barium study
    1. Thickened rugae

VI. Management

VII. Prevention: Critically ill hospitalized patients (ICU)

  1. Indications: High risk patients in ICU
    1. Mechanical Ventilation
    2. Coagulopathy
    3. Multiple traumatic injuries
  2. Protocol
    1. Start GI prophylaxis in high risk ICU patients
      1. Risk of stress-ulcer related GI Bleeding in the ICU: 25%
    2. Discontinue prophylaxis on transfer out of intensive care unit
      1. Risk of Stress Ulcer related GI Bleeding drops to <1% outside the ICU
  3. Option 1: Maintain gastric pH > 4
    1. H2 Antagonist IV infusion
      1. Preparations
        1. Famotidine 20 mg IV every 12 hours
        2. Ranitidine 50 mg IV every 8 hours
        3. Avoid Cimetidine due to drug interactions
        4. Modify dose when GFR <50ml/min
      2. Efficacy
        1. May be preferred over PPI with fewer adverse effects
        2. Some studies suggest similar efficacy in prevention of GI Bleeding
        3. (2014) Presc Lett 21(4): 24
        4. MacLaren (2014) Crit Care Med 42(4): 809-15 [PubMed] (or open in [QxMD Read])
    2. Proton Pump Inhibitor (PPI)
      1. Preparations
        1. Omeprazole (Prilosec) 20-40 mg orally daily
        2. Pantoprazole (Protonix) 40 mg IV daily
      2. Adverse effects
        1. Risk of Nosocomial Pneumonia (Protect against Aspiration Pneumonia)
        2. Risk of Clostridium difficile
      3. Efficacy
        1. May be more effective than H2 Blockers in ICU Stress Ulcer related GI Bleeding (variable evidence)
          1. Alhazzani (2013) Crit Care Med 41(3): 693-705 [PubMed] (or open in [QxMD Read])
  4. Option 2: Topical protectants
    1. Sucralfate (carafate) slurry 1 g PO q6h
    2. Misoprostol 200 ug PO qid
    3. Less risk of Aspiration Pneumonia than Option 1

Images: Related links to external sites (from Google)

Ontology: Curling Ulcer (C0010474)

Definition (MSH) Acute stress DUODENAL ULCER, usually observed in patients with extensive third-degree burns.
Concepts Disease or Syndrome (T047)
MSH D004381
SnomedCT 39755000
English Ulcer, Curling's, Curling's Ulcer, Curlings Ulcer, ULCER, CURLINGS, ULCER, GASTROINTESTINAL, FOLLOWING BURN, Curling's ulcer, Curling ulcers, Curling Ulcer, curling ulcer, curlings ulcer, curling ulcers, curling's ulcer, curlings ulcers, Ulcer, Curling, Curling's ulcers, Curling's ulcers (disorder), Curling
Italian Ulcera di Curling
Japanese カーリング潰瘍, カーリングカイヨウ
Czech Curlingův vřed
French Ulcère de Curling
German Curling-Ulkus
Hungarian Curling fekély
Spanish úlceras de Curling (trastorno), úlceras de Curling, Ulcera de Curling, Úlcera de Curling
Dutch Curling-ulcus
Portuguese Úlcera de Curling

Ontology: Acute gastric mucosal erosion (C0267112)

Concepts Disease or Syndrome (T047)
ICD10 K25
SnomedCT 444926003, 2367005, 18338004, 18665000, 182945005
English Acute gastric mucosal erosion, NOS, acute erosive gastritis (diagnosis), acute erosive gastritis, Acute gastric mucosal erosion, Acute gastric erosions, erosion (acute) of stomach, Acute erosive gastritis (disorder), Acute erosive gastritis, Erosion;gastric;acute, acute gastric erosions, gastritis erosive, erosive gastritis, haemorrhagic gastritis, acute hemorrhagic gastritis, erosive gastropathy, gastritis hemorrhagic, haemorrhagic gastriti, hemorrhagic gastritis, Acute erosion of stomach, Acute gastric mucosal erosion (disorder), acute gastric erosion
Dutch acute maagerosies
French Erosions gastriques aiguëes
German akute Magenerosionen
Italian Erosioni gastriche acute
Portuguese Erosões gástricas agudas
Spanish Erosiones gástricas agudas, gastritis erosiva aguda, gastritis aguda erosiva, gastritis erosiva aguda (trastorno), erosión aguda de la mucosa gástrica, erosión aguda de la mucosa gástrica (trastorno), erosión mucosa gástrica aguda (trastorno), erosión mucosa gástrica aguda, erosión aguda de estómago
Japanese 急性胃粘膜びらん, キュウセイイネンマクビラン
Czech Akutní žaludeční eroze
Hungarian Acut gastrikus erosiók