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Curling’s Ulcer

An ulcer is a breach in continuity of the human skin or mucous membrane. Among the various types of ulcers, Curling’s ulcer is a notable one. The ulcers were first described by Curling in 1842. He was the first man to associate gastrointestinal ulcers with severe burn injury. In severe burn injury, the victim usually goes into hypovolumia, shock and kidney failure. To complicate this situation, the patient may have severe stomach or duodenal injury resulting into formation of ulcer. An ulcer is a breach in continuity of the human skin or mucous membrane. Among the various types of ulcers, Curling’s ulcer is a notable one. The ulcers were first described by Curling in 1842. He was the first man to associate gastrointestinal ulcers with severe burn injury. In severe burn injury, the victim usually goes into hypovolumia, shock and kidney failure. To complicate this situation, the patient may have severe stomach or duodenal injury resulting into formation of ulcer. These stomach or duodenal ulcers associated with severe thermal injury are known as Curling’s ulcers. Curling’s ulcers can occur any where in the stomach, lower end of esophagus or duodenum. First part of the duodenum is the most susceptible area in the whole duodenum. It has been seen that Curling’s ulcer occurs due to bacterial infection in the blood. The burn patients are more prone to develop severe bacterial infection. This bacteraemia along with hypovolumic injury and gastric and duodenal mucosa lead to the formation of Curling’s ulcers.

Two major types of complications are noted in case of Curling’s ulcers. These ulcers may bleed and result in the passing of occult blood with stool and thereby create anemic conditions. This bleeding is severe at times and the patient must be advised to go for blood transfusions in order to combat severe anemia. Another dreaded complication of Curling’s ulcer is perforation. In Curling’s ulcer, there is a chance of perforation of stomach wall or duodenal wall. If it happens, then, the contents of the stomach or duodenum are then passed into peritoneal cavity and that might lead to generalized peritonitis. This may further aggravate the shock, which is already present in the patient due to burn injury. In this case, abdomen will be as rigid as a cardboard.

Nowadays, the incidence of Curling’s ulcers has been significantly reduced. The burn patients are now getting better treatment and cure facilities. The infection in burn patients can now be controlled in a better way especially after the advent of various types of broad spectrum antibiotics. All these improvements have reduced the possibilities for the formation of Curling’s ulcer. Moreover, enteral feeding by nasogastric Ryle’s tube also reduces the bacterial load in the stomach and duodenum and thereby helps to reduce the chance of developing Curling’s ulcer. In the earlier days, antacids were given via nasogastric tube to the burn patients to prevent the development of Curling’s ulcer. But, nowadays, we have lots of drug options like H2 receptor blocker (Ranitidine, Famotidine) or proton pump inhibitor (Omeprazole, Pantoprazole, Rabeprazole, Lansoprazole), which can control the acid secretion from the stomach very effectively. These drugs are used prophylactically in case of burn patients. So, Curling’s ulcers can now be considered as mere historical entity.

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