Acute Gastroduodenal Disease after Thermal Injury

Abstract

To determine the incidence and the natural history of acute gastroduodenal disease after thermal injury, early and serial gastroduodenoscopies were performed in 32 adult patients with burns. Gastric erosions were present in 25 of 29 (86 per cent) with large burns. Seventeen of 23 (74 per cent) had lesions within 72 hours after the burn. In seven patients (22 per cent) a gastric ulcer developed. Ulcerations occurred only in diffusely abnormal areas and were not discovered before 72 hours after the burn. Nine patients (28 per cent) had a duodenal ulceration; all but one had concomitant gastric disease. In two cases, an ulcer was observed to evolve from an erosive "duodenitis." The early development, morphology and histology of the lesions suggested ischemic damage of the mucosa. Nine of 15 patients studied serially had progression of mucosal disease; sepsis, hypotension and hypoxia complicated the clinical course. Life-threatening hemorrhage or perforation occurred mainly in patients with ulcers (eight of nine cases). (N Engl J Med 291:925–929, 1974)