Progress in the treatment of acute gastroduodenal mucosal lesions (AGML)

Abstract

This article presents an analysis of acute gastroduodenal mucosal lesions (AGML) based on a review of current literature and the personal experience of the authors. The pathology of AGML involes two distinct types of lesions, namely, superficial erosions confined to the acid-secreting gastric mucosa and presenting as erosive hemorrhagic gastritis, and acute ulcers that occur in the alkaline gastric mucosa and duodenum. The etiology of these two lesions is very likely different. Acut gastroduodenal ulcers, best known as stress ulcers, are probably "peptic" lesions, whereas erosive hemorrhagic gastritis appears to be due to pathologic back diffusion of hydrogen ions caused by a breakdown of the gastric mucosal barrier as a result of endogenous factors, such as gastric mucosal ischemia, and sometimes exogenous factors, such as alcohol, urea, and acetylsalicylic acid. Catecholamine hypersecretion resulting from severe stress, such as occurs in hypovolemia, sepsis, and hypercapnea, contributes to ischemia of the gastric mucosa by producing splanchnic vasoconstriction. The key to the diagnosis of AGML is early endoscopy in all cases of upper gastrointestinal bleeding. Therapy for AGML should begin with a trial of medical measures directed at restoring effective perfusion of tissues and removing hydrogen ions from the stomach by gastric washing. Medical therapy is effective in 80% of patients with erosive hemorrhagic gastritis, but surgical treatment is usually required in acute gastroduodenal ulcer. When surgery is necessary for either type of lesion, vagotomy with hemigastrectomy appears to be the most effective operation. The personal experience of the authors has involved 36 patients with AGML who were treated in three periods between 1968 and 1976. The mortality rate of patients with AGML has been reduced from 50% in the first 2 years to zero in the last 2 years by the use of emergency endoscopy for diagnosis, appropriate medical therapy, properly timed and executed surgery, and, most recently, selective angiography.

The potential of melatonin in reducing morbidity–mortality after craniocerebral trauma

“…The hypersecretion of catecholamines resulting from severe stress, such as occurs in hypovolemia, sepsis, shock, multiple organ failure, trauma, burns, and major surgery, contributes to ischemia of the gastric mucosa by producing vasoconstriction. At the same time, the ischemia induces diffusion of hydrogen ions and the breakdown of the gastric mucosal barrier [93]. Thus, the patients with CCT have a higher incidence and risk for the development of hemorrhage and perforating gastrointestinal lesions.…”

A Case of Acute Gastric Mucosal Lesions Associated with Helicobacter heilmannii Infection

“…Acute gastric mucosal lesions are a typical clinical entity in acute gastritis, and are characterized by severe erosion, hemorrhage, ulceration or a combination of these [16,17]. Classically, acute gastric mucosal lesions describe stress lesions, but nonsteroidal anti‐inflammatory drugs (NSAIDs), chemicals, alcohol, and infectious agents are associated with such lesions [16–18].…”

Das Stressulcus

“…h~morrhagische Gastritis oder Duodenitis, akutes Magen-Darm-Geschw~ir, Cushing-Ulcus, Curling-Ulcus, akute Magenschleimhautsch~idigung (ASS), acute gastric mucosal lesion (AGML) [39] u.~i.m, linden Verwendung zur Bezeichnung des gleichen Ph/inomens der sekund~ir auftretenden, akuten Schleimhautblutung des oberen Magen-Darm-Traktes im Rahmen einer anderen Prim/irerkrankung. Begriffe wie erosive bzw.…”

“…Unter den operativen Verfahren kommt der Vagotomie hervorragende Bedeutung zu [9,27,39]. Neben der S~iuredepression gelingt hierdurch eine Senkung der Magenschleimhautdurchblutung/iber eine Offnung der submuk6sen Shunts.…”

“…M6glicherweise liegt hier gleichzeitig die Ursache fiir die schlechten Ergebnisse der Vagotomie zur Prophylaxe des Stressulcus [32]. Zur Zeit ist die Diskussion offen dariiber, ob eine zus~itzliche Hemigastrektomie, Ulcus-iibern~ihung oder nur, wenn iiberhaupt, eine Pyloroplastik angefiigt werden sollte [9,27,39]. Hingegen ist die Ulcusabheilung bei vagotomierten Tieren deutlich beschleunigt [35].…”