Stress-induced gastritis

Stress-induced gastritis

    * Introduction
    * Symptoms and Diagnosis
    * Treatment
Stress-induced gastritis erosive stress syndrome, stress ulcer syndrome and stress-induced gastric mucosal disease can cause mucosal erosions and superficial bleeding in patients who are seriously ill or who are under maximum physiological stress. Patients who may be at increased risk of stress gastritis are those with massive burns, head trauma associated with increased intracranial pressure, sepsis and positive blood cultures, severe trauma and multiple organ failure.
Among patients who are seriously ill 6% the gastric bleeding. After some studies show evidence of bleeding intraepithelial endoscopy at 52-100% of critically ill patients 24 hours after the onset of stress factor. Mortality and morbidity are increased in elderly patients due to several factors, including atherosclerosis, which leads to reduced intake and decreased blood host defense. Lead to reduced severity of infringement of the gastrointestinal tract and reduced blood perfusion to the gastric mucosa at risk for ischemic gastritis. This may help to overcome Helicobacter pylori gastric mucosal barrier and installation of stress gastritis.
The clinical picture of patients with gastritis of stress include haematemesis and vomiting "coffee grounds", melena (black stool-format oil with characteristic odor of digested blood).
The goal of treatment is prevention of stress gastritis, using antacids, gastric mucosal protective-sucralfate, histamine antagonists, proton pump inhibitors. It is also important relaxation therapy, psychological stress in people, prevent job with great responsibility, conflict avoidance and treatment of psychological conditions.
Pathogens.
Acid is secreted by parietal cells of gastric mucosa under the influence or activities of biological agents (histamine, gastrin, vagal nerve stimulation). Mucosa is protected by a mucous gel under the influence of prostaglandins, nitric oxide, trefoil proteins and vagal nerve stimulation. The mucous layer forms a barrier between the acidic pH of stomach and gastric epithelium. In the presence of agents or predisposing conditions this protective layer is destroyed, so the acid can cause diffuse mucosal lesions and gastric epithelium.
Two entities play a role in mucosal barrier loss: gastric acid secretion and defense mechanisms. The stress gastritis, gastric acid secretion is normal or increased, so the acid hypersecretion is not a significant etiologic factor. Loss of mucus barrier that protects the main causes. Defense mechanisms, particularly secretion of mucus tends to show a decrease in the concentration of bicarbonate and thus unable to buffer the protons in the stomach. Stress lowers blood flow to the mucosa leading to mucosal ischemia secondary to destruction.
Causes and risk factors.
Prolonged mechanical ventilation and coagulopathy increases the propensity for stress gastritis. Causative factors include the following: Trauma, severe burns, massive -Hypotension, sepsis with positive blood cultures -Central nervous system trauma with increased intracranial pressure -Mechanical ventilation, organ failure.