Stress gastropathy

Although the overall prevalence is unknown, most critically ill infants and children are prone to develop stress-related gastropathy. In infants, stress gastropathy is usually related to traumatic delivery, respiratory or cardiac failure, sepsis, hypoglycemia or dehydration, while in older children it is related to severe life-threatening illness (e.g. respiratory or cardiac failure), intracranial lesion, trauma, burns, coagulopathy, or vasculitis.23 Endoscopic features include isolated gastroduodenal erosions, usually in the fundus and proximal body, and, in severe cases, mucosal ulcerations occurring at multiple sites within the stomach and duodenum (Figure 7.1). The majority of patients develop erosions and ulcers within minutes to hours after the initial insult, and the most common presenting symptoms are hematemesis and melena rather than abdominal

Ménétrier's disease 99

Cherry Red Spots Duodenum
Figure 7.1 Congested gastric mucosa in an infant with stress hemorrhagic vomiting. The mucosa shows nonconfluent cherry red spots on a finely granular background.

pain. Recently, Chaibou et al showed that more than 10% of children admitted to an intensive care unit experienced upper gastrointestinal bleeding, but the bleeding was clinically significant in only 1.6% of them.24

Alterations of the mucosal microcirculation and mucosal ischemia have been implicated in the pathogenesis of stress-induced gastropathy, even though other mechanisms have been suggested, such as increased acid output, decreased production of mucus and impairment of local prostaglandin synthesis.

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