ABSTRACT
Stress ulceration or stress-related mucosal damage is distinct from peptic ulcer disease. Ulcers arising from critical illness are superficial, well demarcated, often multiple and not associated with surrounding oedema. They are usually located in the fundus of the stomach or the first part of the duodenum. Stress ulceration occurs in critically ill patients as a result of major physiological disturbances. The incidence of stress ulceration is poorly understood but has been quoted as ranging from 52 to 100% of all patients admitted to intensive care units (ICUs), depending on the diagnostic criteria used. The finding of occult blood on testing of either gastric aspirate or faecal material produces an unacceptably high incidence of false positive results when looking for stress ulceration. Adopting the stricter diagnostic criteria of overt bleeding or a decrease in haemoglobin of more than 2g dl−1, and complicated by either haemodynamic instability or the need for transfusion of red cells, produces an incidence <5%.
