Stress-Induced Gastritis Clinical Presentation

  • Author: Rohan C Clarke, MD; Chief Editor: Julian Katz, MD   more...
 
Updated: Jul 22, 2011
 

History

Patients who may have an increased risk of stress gastritis are those with massive burn injury, head injury associated with raised intracranial pressure, sepsis and positive blood culture results, severe trauma, and multiple system organ failure. The clinician should have a high incidence of suspicion for patients in these settings who are noted to have decreased hematocrit values and who are not receiving prophylaxis for stress gastritis.

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Physical

Clinical presentation is varied, but the following clues should raise the level of clinical suspicion for this entity:

  • Coffee ground vomitus
  • Melena
  • Hematemesis (in extreme cases)
  • Orthostasis (unusual)
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Causes

Prolonged mechanical ventilation and coagulopathy increase predisposition to stress gastritis. Causative factors include the following conditions:

  • Severe trauma
  • Massive burns
  • Hypotension
  • Sepsis with positive blood culture results
  • CNS injury with raised intracranial pressure
  • Mechanical ventilation
  • Multiorgan failure
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Contributor Information and Disclosures
Author

Rohan C Clarke, MD  Consulting Staff, Department of Gastroenterology, JPS Health Systems Hospital

Rohan C Clarke, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, and American Society of Gastrointestinal Endoscopy

Disclosure: Salix Honoraria Round table feedback group

Coauthor(s)

Rachael M Ferraro, DO  Internal Medicine Hospitalist, Torrance Memorial Medical Center, Little Company of Mary Hospital

Rachael M Ferraro, DO is a member of the following medical societies: American College of Osteopathic Internists, American College of Physicians, and American Osteopathic Association

Disclosure: Nothing to disclose.

Emmanuel Gbadehan, MD  Instructor in Clinical Medicine, Columbia University College of Physicians and Surgeons; Consulting Staff, Department of Gastroenterology, Harlem Hospital Center, North General Hospital

Emmanuel Gbadehan, MD is a member of the following medical societies: American College of Physicians, American College of Physicians-American Society of Internal Medicine, American Gastroenterological Association, and American Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Uzodinma R Dim, MD  Clinical Cardiac Electrophysiology Fellow, Division of Cardiovascular Medicine, University of Iowa Hospital and Clinics

Uzodinma R Dim, MD is a member of the following medical societies: American College of Cardiology, American College of Physicians, American Heart Association, American Medical Association, and Association of Black Cardiologists

Disclosure: Nothing to disclose.

Specialty Editor Board

Ann Ouyang, MBBS  Professor, Department of Internal Medicine, Pennsylvania State University College of Medicine; Attending Physician, Division of Gastroenterology and Hepatology, Milton S Hershey Medical Center

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Simmy Bank, MD  Chair, Professor, Department of Internal Medicine, Division of Gastroenterology, Long Island Jewish Hospital, Albert Einstein College of Medicine

Disclosure: Nothing to disclose.

Alex J Mechaber, MD, FACP  Senior Associate Dean for Undergraduate Medical Education, Associate Professor of Medicine, University of Miami Miller School of Medicine

Alex J Mechaber, MD, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, and Society of General Internal Medicine

Disclosure: Nothing to disclose.

Chief Editor

Julian Katz, MD  Clinical Professor of Medicine, Drexel University College of Medicine

Julian Katz, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Geriatrics Society, American Medical Association, American Society for Gastrointestinal Endoscopy, American Society of Law, Medicine & Ethics, American Trauma Society, Association of American Medical Colleges, and Physicians for Social Responsibility

Disclosure: Nothing to disclose.

References

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  11. van Mark A, Spallek M, Groneberg DA, Kessel R, Weiler SW. Correlates shift work with increased risk of gastrointestinal complaints or frequency of gastritis or peptic ulcer in H. pylori-infected shift workers?. Int Arch Occup Environ Health. Dec 11 2009;epub ahead of print. [Medline].

  12. Wolfe M. Stress-related erosive syndrome. In: Bayless T, ed. Current Therapy in Gastroenterology and Liver Disease. 4th ed. St Louis, Mo: Mosby; 1994:139-43.

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  14. Yardley JH, Hendrix TR. Textbook of Gastroenterology. 2nd ed. Philadelphia, Pa: JB Lippincott Co; 2001:1456-93.

 
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