[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [General pathology](https://durgical.com/en/general-pathology/) › [Gastrointestinal tract](https://durgical.com/en/general-pathology/areas/gi/) › Acute gastritis and stress ulcers

# Acute gastritis and stress ulcers

- Lesion

Painkillers, alcohol, bile and severe illness can strip the stomach's protective layer, leading to erosions, bleeding and small ulcers.

Updated Nov 12, 2026

## Key points

- NSAIDs block COX-1 and COX-2, removing prostaglandins E2 and I2 that drive mucus, bicarbonate, blood flow and repair; even selective COX-2 drugs can injure.
- Other causes: alcohol, bile reflux, uraemia, chemotherapy, radiation, caustic ingestion, high altitude.
- Neutrophils above the basement membrane mean active inflammation (gastritis); in the gut ‘acute’ refers to duration, not to the cell type.
- Stress ulcers: multiple, small, anywhere in the stomach, in shock, sepsis or trauma; mainly ischaemic.
- Curling ulcer: proximal duodenum or stomach after severe burns or trauma. Cushing ulcer: stomach, duodenum or oesophagus with intracranial disease, from vagal acid hypersecretion; perforates more often.
- Other bleeding sources: Dieulafoy lesion (large submucosal arteriole) and gastric antral vascular ectasia (watermelon stomach).

## What it is

The stomach survives an acid close to pH 1 thanks to layered defences: mucus and phospholipids, a bicarbonate-rich unstirred layer, tight epithelium that renews itself within days, prostaglandins, and a rich blood supply. When injury outweighs defence the mucosa is damaged. Pathologists call it gastritis when neutrophils are present and gastropathy when inflammatory cells are scarce. Severe physiological stress causes a distinct, ischaemic form: stress-related mucosal disease.

## Structure

- Reactive gastropathy: oedema, vascular congestion, foveolar hyperplasia with corkscrew pits, little inflammation.
- Acute gastritis: neutrophils within the epithelium or gland lumens.
- Erosion: loss of surface epithelium not passing the muscularis mucosae, with fibrin and neutrophils; with haemorrhage, acute erosive haemorrhagic gastritis.
- Stress ulcer: round, usually under one centimetre, base stained brown-black by digested blood; sharp edges, normal adjacent mucosa, no scarring or thick vessels (unlike chronic peptic ulcer).

## Step by step

- An injurious agent or low blood flow weakens one or more defences.
- Acid diffuses back into the lamina propria.
- Epithelial cells die and capillaries leak; neutrophils may be recruited.
- Surface erosions and haemorrhage form.
- If the cause is removed, the mucosa re-epithelializes within days to weeks.

## Named stress-related ulcers

| Ulcer | Setting | Main mechanism |
| --- | --- | --- |
| [Stress ulcer](https://durgical.com/en/conditions/hypovolaemic-shock/) | Shock, sepsis, major trauma | Mucosal ischaemia from hypotension and splanchnic vasoconstriction |
| [Curling ulcer](https://durgical.com/en/conditions/burns/) | Severe burns or trauma | Ischaemia and hypovolaemia; proximal duodenum and stomach |
| [Cushing ulcer](https://durgical.com/en/conditions/raised-intracranial-pressure-and-brain-herniation/) | Intracranial disease or injury | Vagal stimulation and acid hypersecretion; higher risk of perforation |

## Clinical notes

- Most patients in intensive care have some mucosal damage, but clinically significant bleeding is uncommon; acid suppression is used for prevention.
- Watermelon stomach is associated with cirrhosis and systemic sclerosis and causes chronic iron deficiency.

## Memory aid

Burns curl the duodenum; the brain (Cushing) cooks up acid; shock starves the mucosa.

## Test yourself

Think of the answer, then tap the question to see it.

## How do NSAIDs injure the gastric mucosa?

By blocking cyclooxygenase and so the prostaglandins that maintain mucus, bicarbonate, mucosal blood flow and epithelial repair.

## What separates gastritis from gastropathy?

Gastritis has neutrophils (active inflammation); gastropathy is mucosal injury with few or no inflammatory cells.

## Why are Cushing ulcers thought to form?

Intracranial disease stimulates vagal nuclei, causing gastric acid hypersecretion.

## How do acute stress ulcers differ from chronic peptic ulcers?

They are multiple, anywhere in the stomach, and lack the scarring and thickened vessels of chronic ulcers.

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## Elsewhere in DurgiPedia

- [Gastric acid secretion](https://durgical.com/en/physiology/gastric-acid-secretion/)
- [Stomach: gastric glands, parietal and chief cells](https://durgical.com/en/histology/stomach-gastric-glands-parietal-and-chief-cells/)

## Connections

## Related 5

- [Peptic ulcer](https://durgical.com/en/general-pathology/peptic-ulcer/)
- [Helicobacter pylori gastritis](https://durgical.com/en/general-pathology/helicobacter-pylori-gastritis/)
- [Injury by therapeutic drugs: the classic examples](https://durgical.com/en/general-pathology/injury-by-therapeutic-drugs-the-classic-examples/)
- [Alcohol: how it injures the liver, brain, heart and fetus](https://durgical.com/en/general-pathology/alcohol-how-it-injures-the-liver-brain-heart-and-fetus/)
- [Shock: types, stages and the organs it damages](https://durgical.com/en/general-pathology/shock-types-stages-and-the-organs-it-damages/)

## Related conditions 9

- [Upper gastrointestinal bleeding](https://durgical.com/en/conditions/upper-gastrointestinal-bleeding/)
- [Peptic ulcer disease](https://durgical.com/en/conditions/peptic-ulcer-disease/)
- [Burns (thermal, chemical, electrical; inhalation injury)](https://durgical.com/en/conditions/burns/)
- [Raised intracranial pressure and brain herniation](https://durgical.com/en/conditions/raised-intracranial-pressure-and-brain-herniation/)
- [Sepsis and septic shock](https://durgical.com/en/conditions/sepsis-and-septic-shock/)
- [Cirrhosis](https://durgical.com/en/conditions/cirrhosis/)
- [Systemic sclerosis (scleroderma, including CREST)](https://durgical.com/en/conditions/systemic-sclerosis/)
- [Chronic kidney disease](https://durgical.com/en/conditions/chronic-kidney-disease/)
- [Hypovolaemic shock](https://durgical.com/en/conditions/hypovolaemic-shock/)

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Educational content on the mechanisms of disease; not a diagnostic or treatment guide and no substitute for a health professional's advice. No doses are given.

Sources: [Peptic Ulcer Disease](https://www.ncbi.nlm.nih.gov/books/NBK534792/) (StatPearls (NCBI Bookshelf), 2025); [Upper Gastrointestinal Bleeding](https://www.ncbi.nlm.nih.gov/books/NBK470300/) (StatPearls (NCBI Bookshelf), 2025).

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Representative model, for educational purposes only.

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License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/general-pathology/acute-gastritis-and-stress-ulcers/