RESPIRATORY FAILURE HYPOTENSION SEPSIS AND JAUNDICE - A CLINICAL SYNDROME ASSOCIATED WITH LETHAL HEMORRHAGE FROM ACUTE STRESS ULCERATION OF STOMACH

A clinical syndrome of massive bleeding from acute multiple gastric ulcers associated with respiratory failure, hypotension, sepsis, and jaundice developed in eight of 150 consecutive patients admitted to the respiratory-surgical intensive care unit of the Beth Israel Hospital. These ulcers were almost exclusively located in the fundus of the stomach. Only one of these eight patients survived. Twenty-one gastric secretory studies performed in eighteen critically ill patients indicate that increased secretion of acid may be an important cause of this disease. One patient in whom acute gastric ulceration later developed had a maximally stimulated parietal cell mass in the basal state. Patients in whom this lethal complication develops and who do not respond to nonoperative therapy are probably best treated by gastric resection and vagotomy. © 1969.