Cushing ulcer

A Cushing ulcer, named after Harvey Cushing,[1][2] is a gastric ulcer associated with elevated intracranial pressure. It is also called von Rokitansky–Cushing syndrome.[2] Apart from the stomach, ulcers may also develop in the proximal duodenum and distal esophagus.

Cushing ulcer
SpecialtyGeneral surgery

Causes

The mechanism of development of Cushing ulcers is thought to be due to direct stimulation of vagal nuclei as a result of increased intracranial pressure. Brain tumors, traumatic head injury, and other intracranial processes including infections, can cause increased intracranial pressure and lead to overstimulation of the vagus nerve. [3]Efferent fibers of the vagus nerve then release acetylcholine onto gastric parietal cell M3 receptors, causing insertion of hydrogen potassium ATPase vesicles into the apical plasma membrane. The end result is increased secretion of gastric acid with eventual ulceration of the gastric mucosa.

Diagnosis

As Cushing ulcers have a higher incidence of developing after shock, sepsis or trauma, diagnosis should include recent medical history evaluation. Both endoscopy and angiography can be used to locate the lesion or ulcer, though endoscopy is more commonly used as a first-line diagnosis procedure.[4]

Treatment

Most episodes of Cushing ulceration resolve on medical intervention, consisting primarily of rinsing the area with saline and the administration of antacids.[5]

Patients should also be put on proton pump inhibitors during the course of treatment until their intracranial pressure lowers to a normal level. As it is caused due to vagal stimulation, vagotomy is considered as last treatment resort. .

See also

References
  1. synd/982 at Who Named It?
  2. Wijdicks, Eelco F.M. (2011-06-01). "Cushing's Ulcer: The Eponym and His Own". Neurosurgery. 68 (6): 1695–1698. doi:10.1227/neu.0b013e318212babf. ISSN 0148-396X. PMID 21346647.
  3. Kemp WJ, Bashir A, Dababneh H, Cohen-Gadol AA (2015). "Cushing's ulcer: Further reflections". Asian J Neurosurg. 10 (2): 87–94. doi:10.4103/1793-5482.154976. PMC 4421974. PMID 25972936.
  4. Moody, F. G.; Cheung, L. Y. (Dec 1976). "Stress ulcers: their pathogenesis, diagnosis, and treatment". The Surgical Clinics of North America. 56 (6): 1469–1478. doi:10.1016/s0039-6109(16)41099-6. ISSN 0039-6109. PMID 793064.
  5. Marrone, GC; Silen, W (May 1984). "Pathogenesis, diagnosis and treatment of acute gastric mucosal lesions". Clinics in Gastroenterology. 13 (2): 635–50. ISSN 0300-5089. PMID 6430609.


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