Cushing's ulcer

Cushing's Ulcer

Cushing's ulcer is a type of peptic ulcer that is associated with severe head trauma or brain surgery. It is named after the American neurosurgeon Harvey Cushing, who first described the condition. These ulcers are typically found in the stomach, duodenum, or esophagus and are characterized by their acute onset and potential for serious complications such as bleeding or perforation.

Pathophysiology

Cushing's ulcers are believed to result from increased intracranial pressure, which leads to increased vagal stimulation. This, in turn, causes hypersecretion of gastric acid, leading to ulcer formation. The exact mechanism involves the stimulation of the vagus nerve, which increases gastric acid secretion and reduces mucosal blood flow, making the gastric lining more susceptible to damage.

Clinical Presentation

Patients with Cushing's ulcers may present with symptoms of gastrointestinal bleeding, such as hematemesis (vomiting blood) or melena (black, tarry stools). In some cases, the ulcer may perforate, leading to acute abdominal pain and signs of peritonitis. These ulcers are often diagnosed in patients who have recently experienced significant head trauma or have undergone neurosurgery.

Diagnosis

The diagnosis of Cushing's ulcer is typically made based on clinical history and endoscopic findings. An upper gastrointestinal endoscopy can reveal the presence of ulcers in the stomach or duodenum. In patients with a history of head injury or neurosurgery, the presence of such ulcers is highly suggestive of Cushing's ulcer.

Treatment

The management of Cushing's ulcers involves addressing the underlying cause of increased intracranial pressure and reducing gastric acid secretion. Treatment options may include:

• Proton pump inhibitors (PPIs):These medications reduce gastric acid production and promote healing of the ulcer.
• H2 receptor antagonists:These drugs also decrease acid secretion and can be used in the management of Cushing's ulcers.
• Surgical intervention:In cases of severe bleeding or perforation, surgical intervention may be necessary.

Prognosis

The prognosis of Cushing's ulcer depends on the severity of the ulcer and the underlying neurological condition. With appropriate treatment, many patients can recover without significant complications. However, the risk of rebleeding or perforation remains a concern, particularly in patients with ongoing intracranial issues.

Also see

• Peptic ulcer disease
• Stress ulcer
• Gastric acid
• Vagus nerve
• Harvey Cushing