Medical Therapy for Stress Ulcer Prophylaxis
Year: 2003
Type: book-chapter
Abstract: Patients admitted to intensive care units (ICUs) develop a spectrum of gastroduodenal lesions that may result in gastrointestinal (GI) bleeding. These range from superficial erosions to frank ulcers. It has been assumed that mucosal damage in these critically ill patients is related to “physiologic stress” (see below), hence the terms stress ulcers and stress-related GI hemorrhage (1). These lesions most commonly occur in the proximal stomach [differentiating them from nonsteroidal
Table 1
Determining the Impact of Prophylaxis for Stress-Related Gastrointestinal Hemorrhage: Stratification of Patients and Methodologic Quality Assessment
I. Population
A.Setting: medical ICU, surgical ICU, respiratory ICU, neurosurgical ICU, burn unit
B. Patient characteristics
1. Type of risk: hypotension, severe respiratory insufficiency, sepsis, central nervous system injury, multiple trauma, major burns, acute hepatic failure, acute renal failure, coagulopathy, use of high-dose corticosterosds
2. Magnitude of risk: number of risk factors, APACHE score (or similar)
3. Mechanical ventilation (duration)
4. Duration of ICU stay
II. Methodology: randomized, blinded, placebo-controlled
III. Outcomes
A. Definition of bleeding: occult, overt, clinically significant
B. Documentation of lesions and source of bleeding (endoscopically documented?)
C. Mortality
D. Nosocomial pneumonia (definition and documentation)
antiinflammatory drug (NSAID)-induced injury], but they may be found throughout the stomach and duodenum. During the past decade, prophylaxis of stress-related bleeding has been attempted, using a variety of agents [antacids, histamine 2 (H2) receptor antagonists, sucralfate, proton pump inhibitors], and has become routine in most hospitals throughout the world. The rationale for this approach is based on the assumption that stress-related GI hemorrhage is commonplace, on reports of reduction in the incidence of bleeding among patients receiving prophylactic agents, and on the (unproven) expectation that prophylaxis will reduce mortality. Routine prophylaxis for stress-related bleeding is expensive, however, and has potentially adverse consequences; also, the risk of clinically important bleeding appears to have decreased during the past decade independent of the use of prophylaxis (2-5). The issue of what constitutes the most effective means of prophylaxis is also the subject of substantial debate (6-9).
Source: Humana Press eBooks
Author: Robert S. Bresalier
Language: English
Subfield: Gastroenterology
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
OpenAlex ID: W78250616