Digestive Health What You Need to Know About Curling Ulcers By Angelica Bottaro Angelica Bottaro Facebook LinkedIn Angelica Bottaro is a writer with expertise in many facets of health including chronic disease, Lyme disease, nutrition as medicine, and supplementation. Learn about our editorial process Published on June 23, 2022 Medically reviewed by Robert Burakoff, MD, MPH Medically reviewed by Robert Burakoff, MD, MPH LinkedIn Robert Burakoff, MD, MPH, is board-certified in gastroentrology. He is the vice chair for ambulatory services for the department of medicine at Weill Cornell Medical College in New York, where he is also a professor. He was the founding editor and co-editor in chief of Inflammatory Bowel Diseases. Learn about our Medical Expert Board Print Table of Contents View All Table of Contents Symptoms Causes Diagnosis Treatment Prevention Frequently Asked Questions Curling ulcers are stress-driven ulcers that develop in the gastrointestinal (GI) tract when a person experiences a significant physical injury, specifically a burn. The most common symptom associated with curling ulcers is bleeding in the upper GI tract. This article discusses the symptoms, complications, and causes of curling ulcers. Moyo Studio / Getty Images Stress-Related Ulcer Symptoms In some cases, stress-related ulcers may develop without any symptoms at all. However, when symptoms do appear, the most notable is GI tract bleeding. The areas of the GI tract affected could include the esophagus, the stomach, or the first part of the small intestine (duodenum). The bleeding is often enough to require some form of treatment. Other symptoms that can occur when someone develops a curling ulcer include: Fatigue Nausea and/or vomiting Dark and loose stool Abdominal pain What Are Gastric and Duodenal Ulcers? Complications The main complication associated with curling ulcers is perforation, which is when the ulcer manages to create a hole through the entire digestive tract in the area affected. When this happens, digestive juices, as well as food a person eats, can leak through the hole and into the abdominal cavity. Although curling ulcers result in perforation less than 1% of the time, when it does occur, it is considered a medical emergency. Bleeding and Curling Ulcers Since curling ulcers can lead to significant bleeding, in some cases, a person who develops the ulcer may hemorrhage, which is characterized as bleeding from a blood vessel that has been damaged. In the most severe cases, this excessive bleeding can lead to shock. Causes of Curling Ulcers The main cause of curling ulcers is a severe burn that affects over 30% of a person’s body. When a person experiences this injury, their body becomes extremely stressed. That stress leads to the GI tract's erosion, resulting in a curling ulcer. Risk Factors The biggest risk factor attached to developing a curling ulcer is getting a bad burn injury. Typically, the burn has to cover at least one-third of a person’s body. However, this type of ulcer can, in rare cases, appear after burns that seem less severe, such as a sunburn. The sunburn itself has to be severe in nature. Diagnosis To diagnose curling ulcers, healthcare providers will examine the extent of a person’s burn and any symptoms they may be experiencing alongside the burn. If they present with any symptoms of a curling ulcer, an endoscopy will be ordered. An endoscopy is an exam that involves the use of a small tool with a camera located on the end. The tool is placed into the mouth and down into the GI tract to get a better visual of what’s going on. This type of examination can be used alongside a primary burn injury to diagnose curling ulcers. Treatment The first viable treatment for curling ulcers was surgery. However, the treatment for curling ulcers has progressed dramatically in the last five decades. The most common treatment is a high dose of medication used to reduce the amount of stomach acid a person has. These types of medications are known as proton-pump inhibitors. Curling Ulcer Prognosis Curling ulcers respond well to treatment, and people who develop them can often experience a full recovery. People with more severe bleeding caused by the ulcer are more likely to experience a worse prognosis. Prevention Preventing curling ulcers can be difficult because they are a secondary complication of a physical burn injury, and burn injuries are typically accidents. When a person does experience a burn, healthcare providers may prescribe them antacids (medications designed to reduce stomach acid) in an attempt to prevent a curling ulcer from developing. When to See a Healthcare Provider If you have recently experienced a severe burn injury and begin developing symptoms, such as pain in the abdomen, dark and loose stools, or nausea and vomiting, you should contact your healthcare provider. You may have a curling ulcer that requires treatment. What to Eat When You Have an Ulcer Summary Curling ulcers are holes in the gastrointestinal tract that develop after a person experiences great physical stress. The physical injury most associated with curling ulcers is a burn. Burns that are most likely to cause curling ulcers are severe and cover at least 30% of a person’s body. While there are not always symptoms, someone with a curling ulcer could experience bleeding, abdominal pain, nausea or vomiting, dark and loose stools, or fatigue. The only way to diagnose a curling ulcer is through the use of endoscopy. If a person who has experienced a burn develops a curling ulcer, they are typically treated with medication designed to reduce levels of stomach acid so that the damage to the GI tract doesn’t continue to worsen over time. Preventing burns is the best way to avoid curling ulcers, however, taking antacids prescribed by the healthcare provider if you experience a burn can also lower the risk. A Word From Verywell Dealing with a curling ulcer while you are also recovering from a severe burn injury isn’t easy. Fortunately, this complication only develops in a small number of people who have been burned. In the event that you do develop a curling ulcer, your healthcare provider can prescribe you simple treatment to recover. Frequently Asked Questions What are the different types of ulcers? There are several types of ulcers a person can develop: arterial, venous, peptic, and mouth ulcers. While peptic and mouth ulcers affect the inside of the body, such as the GI tract and the mouth, arterial and venous tend to develop on the outside of the body or in areas you can see with your eyes such as different areas of the legs, ankles, or feet. How can you know if you have an ulcer? It can be hard to determine if you have an ulcer because, in some cases, they don’t present with any symptoms. If you develop a curling ulcer, however, you may experience some signs, such as abdominal pain, dark and loose stools, or nausea. These signs should not be ignored if you have recently suffered a physical injury, like a burn. What types of stress can cause a curling ulcer? Physical stress is what drives the development of curling ulcers. More specifically, the physical stress that comes with being badly burned. People who have burns that cover roughly 30% or more of their body are at risk of developing curling ulcers. Learn More: Stress Ulcers What is a kissing ulcer, and what causes it? A kissing ulcer is a type of ulcer that develops opposite the original ulcer. For example, if a person has an ulcer on the left side of their esophagus, it may also cause one to develop on the right side. While they are often associated with ulcers that develop outside the skin, they can also develop within the body in the GI tract. 3 Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Schosheim A, Tobin M, Chawla A. Curling ulcer in the setting of severe sunburn: a case report. World J Gastrointest Endosc. 2020;12(11):500-503. doi:10.4253/wjge.v12.i11.500 UpToDate. Management of stress ulcers. Zhang Y, Zhang Y, Ma S, Shi H, Lu X. A rare case of kissing gastric ulcers caused by trauma. Intractable Rare Dis Res. 2016;5(4):306-307. doi:10.5582/irdr.2016.01061 By Angelica Bottaro Angelica Bottaro is a professional freelance writer with over 5 years of experience. She has been educated in both psychology and journalism, and her dual education has given her the research and writing skills needed to deliver sound and engaging content in the health space. See Our Editorial Process Meet Our Medical Expert Board Share Feedback Was this page helpful? Thanks for your feedback! What is your feedback? Other Helpful Report an Error Submit