Curling's ulcer

Curling's ulcer is an acute peptic ulcer of the duodenum resulting as a complication from severe burns when reduced plasma volume leads to sloughing of the gastric mucosa. The condition was first described in 1823 and named for a doctor, Thomas Blizard Curling, who observed ten such patients in 1842.^[1]

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These stress ulcers were once a common complication of serious burns, presenting in over 10% of cases,^[1] and especially common in child burn victims.^[2] They result in perforation and hemorrhage more often than other forms of intestinal ulceration^[3] and had correspondingly high mortality rates.^[1] While emergency surgery was once the only treatment, combination therapies including enteral feeding with powerful antacids such as H₂-receptor antagonists or, more recently, proton pump inhibitors such as omeprazole have made Curling's ulcer a rare complication.^[4]

A similar condition involving elevated intracranial pressure is known as Cushing ulcer.

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PATHOLOGY

It is thought that the severe hypovolemia that results from burns causes the sloughing off of the protective mucosal coating of the interior of the stomach. Since the protective mucosal barrier is lost the acid acts unpposed resulting ulcers.