What Are Cushing Ulcers?

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Cushing ulcers are deep, gastrointestinal ulcers that develop after a person experiences an injury to their central nervous system (the communication pathway that connects the brain to the rest of the body). Injuries that can lead to the development of a Cushing ulcer include a brain tumor, infection of the central nervous system, or traumatic brain injury.

This article discusses the symptoms, causes, and treatment options for Cushing ulcers. 

Older man experiencing pain due to an ulcer

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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

Cushing Ulcer Prevalence Rates

While the research on how often people develop Cushing ulcers is scarce, it is thought that as many as 20% of people who experience injuries to the central nervous system go on to develop this type of ulcer as a side effect of their original injury.

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.

Physical Stress and Cushing Ulcers

When the brain is injured so severely that it loses some of its functions—because of oxygen loss or a blow to the head—the rest of the body picks up the slack. When that happens, other systems become overly stressed and, in this case, drive the development of Cushing ulcers.

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.

Cushing Ulcers and Bleeding

It’s estimated that roughly 1.5% of people who develop Cushing ulcers have dangerously excessive bleeding.

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.

Cushing Ulcers and H. pylori

The H. pylori bacteria are closely associated with stomach ulcers because the bacteria can weaken the protective coating of the intestines. While it is often investigated in typical ulcer cases, it is less likely in Cushing ulcers because of the traumatic injury to the central nervous system.

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.

Cushing Ulcer Prognosis

With new medication and medical advancements, the survival rate for Cushing ulcers is typically high. Most people can go on to fully recover from the ulcer following treatment. That said, roughly 12.5% of people who die from central nervous system disease do so because their ulcers hemorrhage. This means that, while not everyone with a Cushing ulcer will die because of it, those that have severe bleeding are far more likely to.

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.

When to See a Healthcare Provider

If you experience any of the symptoms associated with Cushing ulcers after experiencing any type of central nervous system injury or infection, you should contact your healthcare provider immediately. This will help diagnose the ulcer and begin treatment early so that it doesn’t progress to perforation or hemorrhage.

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.

Frequently Asked Questions

  • What are the different types of ulcers?

    There are several different types of ulcers, some of which occur within the body, whereas others occur on the outside of the body. Peptic and mouth ulcers, for example, occur within the GI tract and the mouth, respectively. Arterial and venous ulcers tend to develop outside the body or can be seen with the eyes.

  • What is a stress ulcer?

    A stress ulcer is a type of ulcer that develops when the body undergoes heavy physiological stress. They typically develop within the stomach. However, they can occur in other areas of the GI tract, such as the esophagus or upper area of the small intestines.

  • Are Cushing ulcers and curling ulcers the same?

    While both Cushing and curling ulcers develop because of physical stress on the body, they are not the exact same. Cushing ulcers develop after brain and spinal injuries and infections, whereas curling ulcers develop because of a severe burn injury.

  • What is a kissing ulcer?

    When an ulcer develops opposite of another ulcer, it is referred to as a kissing ulcer. They are given that name because they appear to be mimicking or kissing one another.

  • Can ulcers develop in the brain?

    While ulcers can develop because of a brain injury, they don’t develop within the brain. Ulcers form because of excess stomach acid, infection, or other issues within the gastrointestinal tract. In cases of ulcers that occur outside the body, such as arterial and venous, the issue develops because of a lack of blood flow.

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