Clinical and Pathophysiological Aspects of Curling Ulcer: A Comprehensive Exploration of its Manifestations and Therapeutic Approaches

Abstract

Curling's ulcer, also known as stress ulcer, represents a medical entity of considerable significance, characterized by the formation of ulcerative lesions in the gastric or duodenal mucosa in critically ill and traumatized patients. This condition, although infrequent, imposes a significant burden in terms of morbidity and mortality, due to its unpredictable clinical manifestations and its rapid and potentially unfavorable evolution. This article delves into the intricate pathophysiologic mechanisms underlying Curling's ulcer, highlighting the fundamental relationship with physiologic stress and hemodynamic alterations present in conditions such as extensive burns and severe trauma. The cascade of events culminating in mucosal barrier disruption, including tissue ischemia, exaggerated release of free radicals and proinflammatory cytokines, as well as imbalance in the production of gastroprotective prostaglandins, is comprehensively examined. The clinical manifestations and diagnostic challenges associated with Curling's ulcer are explored in detail, emphasizing the need for a high index of suspicion in critically ill patients to avoid delays in detection and treatment. Modern imaging techniques and endoscopic methods that facilitate accurate assessment of ulcerative lesions and their extent are described. In terms of therapeutic strategies, the medical and surgical approaches available to address Curling's ulcer are discussed in depth. The importance of hemodynamic support therapy and stress reduction in preventing ulcer formation is highlighted, as well as the benefits and risks of pharmacologic interventions aimed at mitigating inflammation and promoting mucosal healing are discussed. In addition, criteria for surgical intervention are discussed and guidelines for optimal procedure selection in specific clinical situations are provided. In summary, this article provides a comprehensive overview of Curling's ulcer, from its pathophysiological basis to its clinical implications and treatment options. A detailed understanding of this essential entity in the context of critical and critical care medicine is vital to improve early identification, effective management, and ultimately outcomes in affected patients.