J.Jpn. Surg. Soc.. 82(11): 1327-1338, 1981

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Original article

CLINICAL AND EXPERIMENTAL STUDIES ON ACUTE GASTRIC MUCOSAL LESIONS DUE TO SEPSIS OR SEPTIC SHOCK

In sepsis or septic shock, the massive gastro-intestinal bleeding occurs frequently as a manifestation of multiple organ failures. The clinical analysis of the 37 septic patients with such massive gastrointestinal hemorrhage suggested that circulatory endotoxin seemed to be one of the major causative factors of gastric lesions.
The purpose of this report is to investigate the early gastric mucosal changes after an endotoxin administration in rats by both biochemical and electron microscopic approaches.
Endotoxin shock was induced by intravenous E. coli endotoxin injection in unanesthesized rats. At 12 or 24hrs. after endotoxin administration, extensive hemorrhagic gastritis was observed about 40%. The biochemical results suggested the derangement of lysosomal membrane stability in such gastric mucosa at 3-6hrs. in advance to hemorrhagic changes.
The electron microscopic findings were prominent within one hour after endotoxin injection. Capillary vessels of the lamina propria were extremely dilated, endothelial layer was flattened, and the basal lamina was slightly delineated.
From these findings, it is assumed that one of the major etiologic factors of acute gastric hemorrhage in septic patients might be initially a disorder of the capillary circulation, followed by a marked mucosal edema, cellular metabolic disturbances including the lysosomal membrane damage, and finally acute gastric erosions.

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