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The presence of acid in the gastric lumen is required for an injurious drug to cause clinically significant injury. Injury occurs as a result of the ability of certain drugs to increase the permeability of the mucosa to its own secreted acid lying within the lumen. As the tissue becomes overwhelmed by the diffusing acid, cell death occurs. Drugs that increase the diffusion of acid also interfere with cellular metabolism, an effect that is independent of the ability of the drug to increase diffusion of acid from the lumen into the tissue. However, when metabolic processes of the mucosa are depressed, the ability of the tissue to buffer diffusing acid is impaired. Thus, the quantity of acid diffusing into the tissue is not as important as the buffering capacity of the mucosa. Most instances of drug\u2010induced injury are not clinically apparent, yet significant hemorrhage occurs in some patients. Even though the initial episode of hemorrhage may be severe, aggressive nonoperative treatment usually is sufficient, provided the mucosa is no longer exposed to the injurious agent. Only a few patients require operation, the extent of which is still controversial<\/jats:bold>.<\/jats:p>","DOI":"10.1007\/bf01658289","type":"journal-article","created":{"date-parts":[[2005,5,8]],"date-time":"2005-05-08T08:48:07Z","timestamp":1115542087000},"page":"199-204","source":"Crossref","is-referenced-by-count":19,"title":["Drug\u2010induced gastric mucosal injury"],"prefix":"10.1002","volume":"5","author":[{"given":"David","family":"Fromm","sequence":"first","affiliation":[{"name":"Department of Surgery State University of New York\u2010Upstate Medical Center Syracuse New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[1981,3]]},"reference":[{"key":"e_1_2_1_2_1","unstructured":"Fromm D.:Gastric mucosal \u201cbarrier.\u201d In Physiology of the Digestive Tract Johnson L. Christensen J. Grossman M. Jacobsen E.D. 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