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. 1974 Oct;180(4):538–546. doi: 10.1097/00000658-197410000-00018

Gastric Mucosal Energy Metabolism and “Stress Ulceration,”

Rene Menguy, Y F Masters
PMCID: PMC1344137  PMID: 4278107

Abstract

Acute gastric erosions following hemorrhagic shock (stress ulceration) have been attributed to gastric hyperacidity, altered gastric secretion of mucus and an abnormal permeability of the gastric mucosa to H+. This report aims at presenting evidence supporting an alternate hypothesis: the event linking shock-induced gastric mucosal ischemia to mucosal necrosis is a deficit in gastric mucosal energy metabolism. Our experimental procedure consisted of harvesting the stomachs of rats and rabbits by “stop-freeze” (liquid N2) at different intervals after the induction of hemorrhagic shock. Levels of adenosine-phosphates and of glycolytic intermediates in gastric mucosa were measured. We studied the changes in the levels of these substrates produced by shock as well as by factors capable, when combined with shock, of rendering the gastric mucosa more vulnerable to stress ulceration. The influence of shock and of these modifying factors were evaluated by comparison with data from appropriately designed control experiments. In parallel experiments we examined the frequency of stress ulceration (gross and microscopic) under these same standard conditions. There have emerged from these studies a number of observations all based upon data with the highest statistical significance. The data are consonant with the hypothesis stated above: an energy deficit severe enough to cause cellular necrosis is the event linking shock-induced gastric mucosal ischemia and stress ulceration.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. BRODIE D. A., HANSON H. M. A study of the factors involved in the production of gastric ulcers by the restraint technique. Gastroenterology. 1960 Mar;38:353–360. [PubMed] [Google Scholar]
  2. Bounous G., Sutherland N. G., Mcardle A. H., Gurd F. N. The prophylactic use of an "elemental" diet in experimental hemorrhagic shock and intestinal ischemia. Ann Surg. 1967 Sep;166(3):312–343. doi: 10.1097/00000658-196709000-00002. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Braun S. A., Samson R. H., Norton L., Eiseman B. Bile reflux in experimental stress ulcer. Surgery. 1973 Apr;73(4):521–524. [PubMed] [Google Scholar]
  4. DenBesten L., Hamza K. N. Effect of bile salts on ionic permeability of canine gastric mucosa during experimental shock. Gastroenterology. 1972 Mar;62(3):417–424. [PubMed] [Google Scholar]
  5. Desbaillets L., Menguy R. Inhibition of gastric mucous secretion by ACTH. An experimental study. Am J Dig Dis. 1967 Jun;12(6):582–588. doi: 10.1007/BF02233495. [DOI] [PubMed] [Google Scholar]
  6. Goodman A. A., Frey C. F. Massive upper gastrointestinal hemorrhage following surgical operations. Ann Surg. 1968 Feb;167(2):180–184. doi: 10.1097/00000658-196802000-00004. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Goodman A. A., Osborne M. P. An experimental model and clinical definition of stress ulceration. Surg Gynecol Obstet. 1972 Apr;134(4):563–571. [PubMed] [Google Scholar]
  8. Guilbert J., Bounous G., Gurd F. N. Role of intestinal chyme in the pathogenesis of gastric ulceration following experimental hemorrhagic shock. J Trauma. 1969 Aug;9(8):723–743. doi: 10.1097/00005373-196908000-00010. [DOI] [PubMed] [Google Scholar]
  9. HANSON H. M. RESTRAINT AND GASTRIC ULCERS. J Neuropsychiatr. 1963 Aug;4:390–395. [PubMed] [Google Scholar]
  10. Hamza K. N., DenBesten L. Bile salts producing stress ulcers during experimental shock. Surgery. 1972 Feb;71(2):161–167. [PubMed] [Google Scholar]
  11. Harjola P. T., Sivula A. Gastric ulceration following experimentally induced hypoxia and hemorrhagic shock: in vivo study of pathogenesis in rabbits. Ann Surg. 1966 Jan;163(1):21–28. doi: 10.1097/00000658-196601000-00003. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Ivey K. J. Acute haemorrhagic gastritis: modern concepts based on pathogenesis. Gut. 1971 Sep;12(9):750–754. doi: 10.1136/gut.12.9.750. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Kunzman J. Management of bleeding stress ulcers. Am J Surg. 1970 Jun;119(6):637–639. doi: 10.1016/0002-9610(70)90231-x. [DOI] [PubMed] [Google Scholar]
  14. Lucas C. E., Sugawa C., Riddle J., Rector F., Rosenberg B., Walt A. J. Natural history and surgical dilemma of "stress" gastric bleeding. Arch Surg. 1971 Apr;102(4):266–273. doi: 10.1001/archsurg.1971.01350040028006. [DOI] [PubMed] [Google Scholar]
  15. MENGUY R., MASTERS Y. F. Effect of cortisone on mucoprotein secretion by gastric antrum of dogs: pathogenesis of steroid ulcer. Surgery. 1963 Jul;54:19–28. [PubMed] [Google Scholar]
  16. Max M., Menguy R. Influence of adrenocorticotropin, cortisone, aspirin, and phenylbutazone on the rate of exfoliation and the rate of renewal of gastric mucosal cells. Gastroenterology. 1970 Mar;58(3):329–336. [PubMed] [Google Scholar]
  17. Moody F. G., Aldrete J. S. Hydrogen permeability of canine gastric secretory epithelium during formation of acute superficial erosions. Surgery. 1971 Jul;70(1):154–160. [PubMed] [Google Scholar]
  18. O'Neill J. A., Jr, Pruitt B. A., Jr, Moncrief J. A., Switzer W. E. Studies related to the pathogenesis of Curling's ulcer. J Trauma. 1967 Mar;7(2):275–287. doi: 10.1097/00005373-196703000-00010. [DOI] [PubMed] [Google Scholar]
  19. ROSENBAUM D. K., FRANK E. D., RUTENBURG A. M., FRANK H. A. High-energy phosphate content of liver tissue in experimental hemorrhagic shock; influence of aureomycin. Am J Physiol. 1957 Jan;188(1):86–90. doi: 10.1152/ajplegacy.1956.188.1.86. [DOI] [PubMed] [Google Scholar]
  20. Rhodes J., Barnardo D. E., Phillips S. F., Rovelstad R. A., Hofmann A. F. Increased reflux of bile into the stomach in patients with gastric ulcer. Gastroenterology. 1969 Sep;57(3):241–252. [PubMed] [Google Scholar]
  21. Robert A., Phillips J. P., Nezamis J. E. Production, by restraint, of gastric ulcers and of hydrothorax in the rat. Gastroenterology. 1966 Jul;51(1):75–81. [PubMed] [Google Scholar]
  22. Safaie-Shirazi S., DenBesten L., Hamza K. N. The role of vagotomy in preventing bile salt-induced stress ulcers during hemorrhagic shock. J Trauma. 1972 Aug;12(8):678–681. [PubMed] [Google Scholar]
  23. Skillman J. J., Gould S. A., Chung R. S., Silen W. The gastric mucosal barrier: clinical and experimental studies in critically ill and normal man, and in the rabbit. Ann Surg. 1970 Oct;172(4):564–584. doi: 10.1097/00000658-197010000-00004. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Skillman J. J., Silen W. Acute gastroduodenal "stress" ulceration: barrier disruption of varied pathogenesis? Gastroenterology. 1970 Sep;59(3):478–482. [PubMed] [Google Scholar]

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