This article discusses the symptoms, causes, and treatment options for Cushing ulcers.
Symptoms
A Cushing ulcer can develop in the gastrointestinal tract (GI tract), typically the esophagus, stomach, or upper part of the small intestine (duodenum).
When symptoms develop, they can include:
Vomiting with or without nausea Vomiting blood Pain in the abdomen Weight loss Indigestion Constipation Lethargy Black stools Cramps Gastric pain following a meal Bleeding that may or may not lead to hemorrhage
Complications
In roughly 10% of cases, perforation of the ulcer may occur. Perforation happens when the ulcer opens up through the entire GI tract, creating a hole. The hole then provides a way for stomach juices and food to escape the GI tract and make their way into the abdominal cavity.
Causes of Cushing Ulcers
Cushing ulcers begin with a traumatic injury to the central nervous system. These types of injuries are broken into two categories: primary and secondary.
Primary injuries include things such as skull fractures or blows to the head. Secondary injuries occur following the injury and are more associated with long-term brain damage.
Tumors and other masses that form within the central nervous system and brain can also lead to Cushing ulcers because they affect neurological function. Brain infections are also associated with Cushing ulcers.
Injuries to the brain often increase the pressure within the skull. When the pressure increases, the vagus nerve becomes overstimulated. The vagus nerve system, otherwise known as the parasympathetic nervous system, is tasked with controlling certain functions within the body, such as immunity, heart rate, and digestion.
When the vagus nerve becomes overstimulated, it sends a signal through the body to increase the amount of gastric acid in the stomach, which leads to a Cushing ulcer.
Risk Factors
The biggest risk factor associated with Cushing ulcers is experiencing trauma to the central nervous system. This can include the brain, brain stem, and the spinal cord. However, not everyone who experiences trauma will develop a Cushing ulcer.
There are some other risk factors associated with the development of these ulcers after experiencing brain or spine injuries or infections, such as:
Mechanical ventilation: People who require mechanical ventilation after a head injury are more likely to develop a Cushing ulcer. Intensive care length: There is a direct connection between those who spend longer times in intensive care following an injury and Cushing ulcer development.
Diagnosis
Diagnosing Cushing ulcers is similar to that of other types of ulcers. It begins with a healthcare provider gathering information about symptoms and health history.
In people with ulcer symptoms and a brain injury, tumor, or other injury that affects the pressure within the skull, a Cushing ulcer may be suspected early on.
To figure out if the GI symptoms are, in fact, an ulcer, healthcare providers will investigate the esophagus, stomach, and upper side of the small intestine using an endoscope, which is a small snake-like tool that has a camera on the end. The camera captures the ulcer so that healthcare providers can have a clearer look at the extent of its damage.
Treatment
The main form of treatment for Cushing ulcers is proton-pump inhibitors. These medications are designed to reduce the amount of gastric acid there is within the GI tract so that the damage can be reversed.
In some cases, an H2 antagonist may be used alongside a proton-pump inhibitor because it reduces the amount of stomach acid found in the cells of the stomach lining, further helping to reduce damage to the GI tract.
Prevention
It can be difficult to prevent brain injuries or diseases that lead to Cushing ulcers. That said, when a person does experience injury to their central nervous system, healthcare providers may pre-emptively administer medications designed to hinder the overabundance of stomach acid as a way to decrease the odds of a person developing this type of ulcer.
Summary
Cushing ulcers are gastrointestinal ulcers that develop following injury or infection to the central nervous system. Possible symptoms include pain in the abdomen, vomiting with or without nausea, black stools, and pain after eating. These symptoms may not always develop right away.
Cushing ulcers can develop following a brain injury or infection because the increased skull pressure affects the parasympathetic nervous system or the vagus nerves. When there is increased pressure, this nerve becomes overstimulated and encourages the body to produce more stomach acid, leading to an ulcer.
If your healthcare provider suspects you have a Cushing ulcer, they will gather your symptoms and perform an endoscopy to assess the situation from a better angle. Once they have the proper diagnosis, they can begin treatment with medications designed to decrease stomach acid levels.
A Word From Verywell
Dealing with a traumatic brain or spine injury is difficult on its own, so it can be even more challenging when a Cushing ulcer develops. Fortunately, medical advancements have made treating these types of ulcers much easier. As long as you seek treatment early and pay attention to the signs, you will likely have a full recovery without experiencing serious and negative complications.
