Stress ulcers cause sores in the gastrointestinal (GI) tract. They can cause pain, a burning sensation, and an increased risk of infection. The damage ranges from minor irritation to severe bleeding.

Stress ulcers refer to a type of gastrointestinal (GI) sore that occurs as a result of immense physiological stress and illness, including severe burns, head injuries, and kidney failure.

They most commonly affect the corpus, which is the large part of the stomach that holds food, and the fundus, which is the top part of the stomach.

Stress ulcers typically occur in people receiving intensive care in the hospital. Over the past 20 years, the rates of severe complications have declined due to the development of new treatments.

The primary goal of treatment is to reduce stomach acid and lower the risk of serious infection, bleeding, and shock.

This article examines the causes, symptoms, and treatments of stress ulcers.

Are stress ulcers the same as peptic ulcers?

No, stress ulcers are not the same as peptic (stomach) ulcers.

While both cause sores in the lining of the stomach and intestines, a typical peptic ulcer tends to develop gradually, as drugs or infections weaken the GI lining.

On the other hand, stress ulcers develop more suddenly, typically due to physiological stress.

Stress ulcers can be life threatening because they typically affect people with a severe health condition. Stomach ulcers can be serious, but they are often treatable with medications.

Doctors sometimes use other names to refer to stress ulcers, including:

  • stress-induced ulcers
  • stress ulceration
  • diffuse mucosal injury
  • stress-related mucosal disease
  • hemorrhagic gastritis
  • erosive gastritis
  • Curling’s ulcer (related to severe burns)
  • Cushing’s ulcer (related to traumatic brain injury)
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Stress ulcers are typically caused by severe physiologic stress that can induce or exacerbate damage to the gastric mucosa, which is the inner lining of the stomach.

The stomach naturally produces acid to aid in the digestion of food. Under severe stress, however, the stomach’s acidic environment can become too acidic due to increased toxins and bile salts.

This can strip away the mucus and bicarbonate layer that helps protect the GI lining, potentially leading to the formation of stress ulcers.

Several conditions and physiologic risk factors have been associated with stress ulcers, including:

In individuals under severe physiological stress, ulcers may also develop due to changes in the body’s pH levels. This can cause GI inflammation and increase the secretion of acetylcholine (ACh) and histamine, both of which can elevate stomach acid levels and contribute to the development of ulcers.

In some cases, very significant psychological stress may also trigger or worsen a stress ulcer.

Stress ulcers cause a continuum of symptoms. Minor ulcers may cause no symptoms, while severe ulcers can cause intense pain and lead to serious complications.

Stress ulcers are typically located in the corpus (the larger part) and fundus (the upper part) of the stomach. Sometimes, they can affect the antrum (a small part of the stomach) or the duodenum (the small intestine).

Early symptoms of a stress ulcer may include:

In most cases, however, the first symptoms of a stress ulcer are GI hemorrhage (internal bleeding), which may present as:

  • red vomit or vomit that resembles coffee grounds
  • red or maroon bowel movements
  • very dark, tarry bowel movements
  • feeling light-headed or fainting

People with stress ulcers are usually already in the hospital for another severe condition, so it can be difficult to distinguish ulcer symptoms from symptoms of another illness.

To diagnose a stress ulcer, a healthcare professional must visualize the GI tract. They may use an endoscope — a long, thin tube — to see the ulcer.

Signs of a stress ulcer may include gastric inflammation, ulcerations, and fluid buildup, as well as glands that appear like a corkscrew. Another key sign is whether the endoscope is bloody when removed from the person’s body.

A doctor may also use blood, breath, or stool tests to check for H. pylori bacteria, which are a major risk factor for ulcers.

According to a 2022 review, stress ulcers are classified into three categories, depending on the severity of bleeding in the GI tract:

  1. Occult bleeding: This type of blood loss is invisible but can be detected through various tests. It affects 15% to 50% of people who are critically ill.
  2. Overt bleeding: This may manifest as vomiting blood, having black, tarry stools, or having rectal bleeding. It affects 1.5% to 8.5% of people.
  3. Clinically important bleeding: This severe type of internal bleeding, which occurs in 1% to 3% of critically ill people, affects at least one of a person’s vital signs. It may be accompanied by:

Treatment for stress ulcers will depend on the severity of the ulcer and the symptoms it causes. The primary goal is to reduce stomach acid and lower the risk of serious infections, bleeding, and shock.

The first-line treatment for stress ulcers is proton pump inhibitors (PPIs), a group of drugs that reduce stomach acid.

If these do not help, a doctor may prescribe antihistamine drugs. Some antihistamines are anticholinergic, meaning they block the action of ACh, a neurotransmitter that stimulates processes that cause the stomach to release acid.

In severe cases, a person may require a blood transfusion.

Can a stress ulcer heal itself?

No, in most cases, a stress ulcer will require medical treatment to heal.

Stress ulcers are common in emergency and intensive care settings.

Healthcare professionals may prescribe prophylactic (preventive) drugs to a person and regularly monitor them to prevent stress ulcers. These medications typically include PPIs and histamine blockers, which are the same strategies used to treat ulcers.

Around 3 in 4 people who do not receive prophylaxis during intensive care treatment develop stress ulcers.

They noted that prophylaxis is particularly recommended for people who have certain risk factors of severe complications, such as:

  • use of a ventilator for more than 48 hours
  • history of GI bleeding or an ulcer in the past year
  • severe traumatic brain or spinal injury

Prophylaxis may also be recommended for people who experience several risk factors for stress ulcers, such as:

  • organ failure
  • sepsis
  • use of anti-inflammatory medications or more than 250 mg of glucocorticosteroids
  • hospital stay lasting more than 1 week
  • GI bleeding for at least 6 days

People at risk of developing stress ulcers often have serious health issues, such as infections, organ failure, or head injuries.

A stress ulcer can cause severe inflammation and bleeding, complicating other conditions. This means that stress ulcers are more dangerous than traditional peptic ulcers.

Most people at risk of developing stress ulcers are already in the hospital. If a person has recently had a hospital stay and develops symptoms of an ulcer, they should consult a doctor immediately.

With the right treatment, people can recover from both stress ulcers and the issues that cause them.