The Surgical Management of Acute Gastric Mucosal Bleeding

Abstract

Bleeding from superficial gastric erosions was described for the first time in 1898 by Dieulafoy.¹Since then, our understanding of this condition has increased but little. One of the confusing aspects of this condition is that of semantics. This phenomenon has been variously called "acute erosive gastritis," "acute hemorrhagic gastritis," "Curling's ulcer," "Cushing's ulcer," "acute peptic ulcer," and "stress ulcer." Moreover, because there usually is a break in the continuity of the mucosa (erosion, ulceration, ulcer), often it is labeled "gastric ulcer, bleeding." Also, physicians tend to attribute radiologically negative gastrointestinal (GI) bleeding to "peptic ulceration." As a result, the incidence of this condition is not well known. For instance, in 1964 Sullivan et al²wrote that hemorrhagic gastritis is "... relatively uncommon as a cause of major gastrointestinal bleeding...." Technical improvements in endoscopy have increased the frequency with which a clinical diagnosis of acute gastric mucosal bleeding can