Erosive duodenitis and duodenal ulcers develop in severely burned patients (Fig. 6.126). The inflammatory lesions have an ischemic basis and their pathophysiology resembles that seen in stress ulcers. Gastroduodenal erosions occur within 5 hours of injury (285). Within the first 24 hours the mucosal barrier breaks down, mediated in part by transient intestinal hypoperfusion and increased intestinal permeability. Early ischemia results in enterocyte membrane disruption. Bacterial and luminal endotoxins gain access to the systemic circulation. Another form of thermal injury occurs in GI gunshot wounds. Coagulation necrosis develops along the bullet path, due to the heat.