Stress-induced ulcers of the stomach and duodenum in massively burned patients, otherwise known as Curling's ulcers, result from a defect in the mucosal barrier to secreted acid. The etiology of this defect is related, at least in part, to mucosal ischemia, which is aggravated by hypotension, sepsis, and hypoxia. Early prophylactic administration of antacids and cimetidine, either singly or in combination, has significantly reduced the occurrence of the life-threatening complications of these lesions. When preventive measures have failed or have not been utilized and massive bleeding or perforation has occurred, these complications of Curling's ulcer appear to be best treated by gastric resection combined with vagotomy.
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