Skip to main content

Advertisement

Log in

Stress ulceration: prevalence, pathology and association with adverse outcomes

  • Review
  • Published:
Critical Care Aims and scope Submit manuscript

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Figure 1

Abbreviations

APACHE II:

Acute Physiological and Chronic Health Evaluation II

CABG:

coronary artery bypass graft

CAP:

community-acquired pneumonia

c.i.v.:

continuous intravenous infusion

H2RB:

histamine-2 receptor blocker

ICU:

intensive care unit

i.v.:

intravenous

IVAC:

infection-related ventilator- associated complications

NG:

nasoqastric

PO:

per oral

PPI:

proton pump inhibitors

SRMD:

stress-related mucosal damage

UGI:

upper gastrointestinal

VAP:

ventilator-associated pneumonia.

References

  1. Peura D: Stress-related mucosal damage. Clin Ther 1986,8(A):14-23.

    PubMed  Google Scholar 

  2. Skillman JJ, Bushnell LS, Goldman H, Silen W: Respiratory failure, hypotension, sepsis, and jaundice. A clinical syndrome associated with lethal hemorrhage from acute stress ulceration of the stomach. Am J Surg 1969, 117: 523-530. 10.1016/0002-9610(69)90011-7

    Article  CAS  PubMed  Google Scholar 

  3. Mutlu GM, Mutlu EA, Factor P: GI complications in patients receiving mechanical ventilation. Chest 2001, 119: 1222-1241. 10.1378/chest.119.4.1222

    Article  CAS  PubMed  Google Scholar 

  4. Cook DJ, Fuller HD, Guyatt GH, Marshall JC, Leasa D, Hall R, Winton TL, Rutledge F, Todd TJ, Roy P: Risk factors for gastrointestinal bleeding in critically ill patients. Canadian Critical Care Trials Group. N Engl J Med 1994, 330: 377-381. 10.1056/NEJM199402103300601

    Article  CAS  PubMed  Google Scholar 

  5. Hastinqs PR, Skillman JJ, Bushnell LS, Silen W: Antacid titration in the prevention of acute gastrointestinal bleeding. N Engl J Med 1978, 298: 1041-1045. 10.1056/NEJM197805112981901

    Article  Google Scholar 

  6. Alhazzani W, Alenezi F, Jaeschke RZ, Moayyedi P, Cook DJ: Proton pump inhibitors versus histamine 2 receptor antagonists for stress ulcer prophylaxis in critically ill patients: a systematic review and meta-analysis. Crit Care Med 2013, 41: 693-705. 10.1097/CCM.0b013e3182758734

    Article  CAS  PubMed  Google Scholar 

  7. Faisy C, Guerot E, Diehl JL, Iftimovici E, Faqon JY: Clinically significant gastrointestinal bleeding in critically ill patients with and without stress- ulcer prophylaxis. Intensive Care Med 2003, 29: 1306-1313. 10.1007/s00134-003-1863-3

    Article  PubMed  Google Scholar 

  8. Cook DJ, Griffith LE, Walter SD, Guyatt GH, Meade MO, Heyland DK, Kirby A, Tryba M, Canadian Critical Care Trials Group: The attributable mortality and length of intensive care unit stay of clinically important gastrointestinal bleeding in critically ill patients. Crit Care 2001, 5: 368-375. 10.1186/cc1071

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Marik PE, Vasu T, Hirani A, Pachinburavan M: Stress ulcer prophylaxis in the new millennium: a systematic review and meta-analysis. Crit Care Med 2010, 38: 2222-2228. 10.1097/CCM.0b013e3181f17adf

    Article  PubMed  Google Scholar 

  10. Fiddian-Green RG, Mcqouqh E, Pittenqer G, Rothman E: Predictive value of intramural pH and other risk factors for massive bleeding from stress ulceration. Gastroenterology 1983, 85: 613-620.

    CAS  PubMed  Google Scholar 

  11. Vincent JL: Give your patient a fast hug (at least) once a day. Crit Care Med 2005, 33: 1225-1229. 10.1097/01.CCM.0000165962.16682.46

    Article  PubMed  Google Scholar 

  12. Dellinger RP, Levy MM, Rhodes A, Annane D, Gerlach H, Opal SM, Sevransky JE, Sprunq CL, Douqlas IS, Jaeschke R, Osborn TM, Nunnally ME, Townsend SR, Reihart K, Kleinpell RM, Angus DC, Deutschman CS, Machado FR, Rubenfield GD, Webb SA, Beale RJ, Vincent JL, Moreno R: Surviving Sepsis Campaiqr Guidelines Committee including the Pediatric Subgroup: Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock: 2012. Crit Care Med 2013, 41: 580-637. 10.1097/CCM.0b013e31827e83af

    Article  PubMed  Google Scholar 

  13. Cook DJ, Reeve BK, Guyatt GH, Heyland DK, Griffith LE, Buckingham L, Tryba M: Stress ulcer prophylaxis in critically ill patients. Resolving discordant meta-analyses. JAMA 1996, 275: 308-314. 10.1001/jama.1996.03530280060038

    Article  CAS  PubMed  Google Scholar 

  14. Daley RJ, Rebuck JA, Welaqe LS, Rogers FB: Prevention of stress ulceration: current trends in critical care. Crit Care Med 2004, 32: 2008-2013. 10.1097/01.CCM.0000142398.73762.20

    Article  PubMed  Google Scholar 

  15. Guy C, Ollaqnier M: Sucralfate and bezoars: data from the system of pharmacologic vigilance and review of the literature. Therapie 1999, 54: 55-58.

    CAS  PubMed  Google Scholar 

  16. Netzer P, Gaia C, Sandoz M, Huluk T, Gut A, Halter F, Hüsler J, Inaunen W: Effect of repeated injection and continuous infusion of omeprazole and ranitidine on intragastric pH over 72 hours. Am J Gastroenterol 1999, 94: 351-357.

    CAS  PubMed  Google Scholar 

  17. Powell H, Morgan M, Li SK, Baron J: Inhibition of gastric acid secretion in the intensive care unit after coronary artery bypass graft. A pilot control study of intravenous omeprazole by bolus and infusion, ranitidine and placebo. Theor Surg 1993, 8: 125-130.

    Google Scholar 

  18. Risaliti ATG, Uzzau A: Intravenous omeprazole vs ranitidine in the prophylaxis of stress ulcers. Acta ChirItal 1993, 49: 397-401.

    Google Scholar 

  19. Levy MJ, Seeliq CB, Robinson NJ, Ranney JE: Comparison of omeprazole and ranitidine for stress ulcer prophylaxis. Dig Dis Sci 1997, 42: 1255-1259. 10.1023/A:1018810325370

    Article  CAS  PubMed  Google Scholar 

  20. Lasky MR, Metzler MH, Phillips JO: A prospective study of omeprazole suspension to prevent clinically significant gastrointestinal bleeding from stress ulcers in mechanically ventilated trauma patients. J Trauma 1998, 44: 527-533. 10.1097/00005373-199803000-00020

    Article  CAS  PubMed  Google Scholar 

  21. Phillips JO, Metzler MH, Huckfeldt RE, Olsen K: Multicenter prospective randomized clinical trial of continuous infusion I.V. Ranitidine vs. Omeprazole suspension in the prophylaxis of stress ulcers. Crit Care Med 1998, 26: 101A.

    Google Scholar 

  22. Azevedo SM Jr, Silva G, Palacio G: Prevention of stress ulcer bleeding in high risk patients. Comparison of three drugs. Crit Care Med 1999, 27: A145.

    Article  Google Scholar 

  23. Kantorova I, Svoboda P, Scheer P, Doubek J, Rehorkova D, Bosakova H, Ochmann J: Stress ulcer prophylaxis in critically ill patients: a randomized controlled trial. Hepatogastroenterology 2004, 51: 757-761.

    PubMed  Google Scholar 

  24. Pan XZW, Li Z: The preventive effects of rabeprazole on upper gastrointestinal tract hemorrhage in patients with severe acute pancreatitis. Chin J Gastroenterol 2004, 9: 30-32.

    Google Scholar 

  25. Conrad SA, Gabrielli A, Margolis B, Quartin A, Hata JS, Frank WO, Bagin RG, Rock JA, Hepburn B, Laine L: Randomized, double-blind comparison of immediate-release omeprazole oral suspension versus intravenous cimetidine for the prevention of upper gastrointestinal bleeding in critically ill patients. Crit Care Med 2005, 33: 760-765. 10.1097/01.CCM.0000157751.92249.32

    Article  CAS  PubMed  Google Scholar 

  26. Hata M, Shiono M, Sekino H, Furukawa H, Sezai A, lida M, Yoshitake I, Hattori T, Wakui S, Soeda M, Taoka M, Negishi N, Sezai Y: Prospective randomized trial for optimal prophylactic treatment of the upper gastrointestinal complications after open heart surgery. Circ J 2005, 69: 331-334. 10.1253/circj.69.331

    Article  CAS  PubMed  Google Scholar 

  27. Kotlyanskaya A, Luka B, Mukherji R: A comparison of lansoprazole disintegrating tabletlansoprazole suspension or ranitidine for stress ulcer prophylaxis in critically ill patients. Crit Care Med 2008, 7: A194.

    Google Scholar 

  28. Somberg L, Morris J Jr, Fantus R, Graepel J, Field BG, Lynn R, Karlstadt R: Intermittent intravenous pantoprazole and continuous cimetidine infusion: effect on gastric pH control in critically ill patients at risk of developing stress-related mucosal disease. J Trauma 2008, 64: 1202-1210. 10.1097/TA.0b013e31815e40b5

    Article  CAS  PubMed  Google Scholar 

  29. Solouki MMS, Kouchak M: Comparison between the preventive effects of ranitidine and omeprazole on upper gastrointestinal bleeding among ICU patients. Tanaffos 2009, 8: 37-42.

    Google Scholar 

  30. Heyland D, Bradley C, Mandell LA: Effect of acidified enteral feedings on gastric colonization in the critically ill patient. Crit Care Med 1992, 20: 1388-1394. 10.1097/00003246-199210000-00005

    Article  CAS  PubMed  Google Scholar 

  31. Klompas M: Complications of mechanical ventilation - the CDC's new surveillance paradigm. N Engl J Med 2013, 368: 1472-1475. 10.1056/NEJMp1300633

    Article  CAS  PubMed  Google Scholar 

  32. Chapman MJ, Nguyen NQ, Deane AM: Gastrointestinal dysmotility: clinical consequences and management of the critically ill patient. Gastroenterol Clin North Am 2011, 40: 725-739. 10.1016/j.gtc.2011.09.003

    Article  PubMed  Google Scholar 

  33. Laheij RJ, Sturkenboom MC, Hassing RJ, Dieleman J, Stricker BH, Jansen JB: Risk of community-acquired pneumonia and use of gastric acid- suppressive drugs. JAMA 2004, 292: 1955-1960. 10.1001/jama.292.16.1955

    Article  CAS  PubMed  Google Scholar 

  34. Prod'hom G, Leuenberger P, Koerfer J, Blum A, Chiolero R, Schaller MD, Perret C, Spinnler O, Blondel J, Siegrist H, Saghafi L, Blanc D, Francioli P: Nosocomial pneumonia in mechanically ventilated patients receiving antacid, ranitidine, or sucralfate as prophylaxis for stress ulcer. A randomized controlled trial. Ann intern Med 1994, 120: 653-662. 10.7326/0003-4819-120-8-199404150-00005

    Article  PubMed  Google Scholar 

  35. Heyland DK, Cook DJ, Schoenfeld PS, Frietag A, Varon J, Wood G: The effect of acidified enteral feeds on gastric colonization in critically ill patients: results of a multicenter randomized trial. Canadian Critical Care Trials Group. Crit Care Med 1999, 27: 2399-2406. 10.1097/00003246-199911000-00013

    Article  CAS  PubMed  Google Scholar 

  36. Jacobs S, Chang RW, Lee B, Bartlett FW: Continuous enteral feeding: a major cause of pneumonia among ventilated intensive care unit patients. JPEN J Parenter Enteral Nutr 1990, 14: 353-356. 10.1177/0148607190014004353

    Article  CAS  PubMed  Google Scholar 

  37. Zilberberg MD, Nathanson BH, Sadigov S, Higgins TL, Kollef MH, Shorr AF: Epidemiology and outcomes of clostridium difficile-associated disease among atients on prolonged acute mechanical ventilation. Chest 2009, 136: 752-758.

    Article  PubMed  Google Scholar 

  38. Howell MD, Novack V, Grgurich P, et al.: Iatrogenic gastric acid suppression and the risk of nosocomial Clostridium difficile infection. Arch Intern Med 2010, 170: 784-790. 10.1001/archinternmed.2010.89

    Article  PubMed  Google Scholar 

  39. Yearsley KA, Gilby LJ, Ramadas AV, Kubiak EM, Fone DL, Allison MC: Proton pump inhibitor therapy is a risk factor for Clostridium difficile-associated diarrhoea. Aliment Pharmacol Ther 2006, 24: 613-619. 10.1111/j.1365-2036.2006.03015.x

    Article  CAS  PubMed  Google Scholar 

  40. Khalili H, Huang ES, Jacobson BC, Camargo CA Jr, Feskanich D, Chan AT: Use of proton pump inhibitors and risk of hip fracture in relation to dietary and lifestyle factors: a prospective cohort study. BMJ 2012, 344: e372. 10.1136/bmj.e372

    Article  PubMed  PubMed Central  Google Scholar 

  41. Farley KJ, Barned KL, Crozier TM: Inappropriate continuation of stress ulcer prophylaxis beyond the intensive care setting. Crit Care Resusc 2013, 15: 147-151.

    CAS  PubMed  Google Scholar 

  42. Deane AM, Dhaliwal R, Day AG, Ridley EJ, Davies AR, Heyland DK: Comparisons between intragastric and small intestinal delivery of enteral nutrition in the critically ill: a systematic review and meta-analysis. Crit Care 2013, 17: R125. 10.1186/cc12800

    Article  PubMed  Google Scholar 

  43. Ephgrave KS, Kleiman-Wexler RL, Adair CG: Enteral nutrients prevent stress ulceration and increase intragastric volume. Crit Care Med 1990, 18: 621-624. 10.1097/00003246-199006000-00009

    Article  CAS  PubMed  Google Scholar 

  44. Sim JA, Horowitz M, Summers MJ, Trahair LG, Goud RS, Zaknic AV, Hausken T, Fraser JD, Chapman MJ, Jones KL, Deane AM: Mesenteric blood flow, glucose absorption and blood pressure responses to small intestinal glucose in critically ill patients older than 65 years. intensive Care Med 2013, 39: 258-266. 10.1007/s00134-012-2719-5

    Article  PubMed  Google Scholar 

  45. Bonten MJ, Gaillard CA, Van Tiel FH, Van Der Geest S, Stobberingh EE: Continuous enteral feeding counteracts preventive measures for gastric colonization in intensive care unit patients. Crit Care Med 1994, 22: 939-944. 10.1097/00003246-199406000-00010

    Article  CAS  PubMed  Google Scholar 

  46. Harju E, Sajanti J: The protective effect of nutrients against stress induced gastric ulcers in the rat. Surg GynecolObstet 1987, 165: 530-534.

    CAS  Google Scholar 

  47. Stollman N, Metz DC: Pathophysiology and prophylaxis of stress ulcer in intensive care unit patients. J Crit Care 2005, 20: 35-45. 10.1016/j.jcrc.2004.10.003

    Article  PubMed  Google Scholar 

  48. Ben-Menachem T, Mccarthy BD, Fogel R, Schiffman RM, Patel RV, Zarowtiz BJ, Nerenz DR, Bresalier RS: Prophylaxis for stress-related gastrointestinal hemorrhage: a cost effectiveness analysis. Crit Care Med 1996, 24: 338-345. 10.1097/00003246-199602000-00026

    Article  CAS  PubMed  Google Scholar 

  49. Devlin JW, Claire KS, Dulchavsky SA, Tyburski JG: Impact of trauma stress ulcer prophylaxis guidelines on drug cost and frequency of major gastrointestinal bleeding. Pharmacotherapy 1999, 19: 452-460. 10.1592/phco.19.6.452.31049

    Article  CAS  PubMed  Google Scholar 

  50. Cash BD: Evidence-based medicine as it applies to acid suppression in the hospitalized patient. Crit Care Med 2002, 30: S373-S378. 10.1097/00003246-200206001-00008

    Article  PubMed  Google Scholar 

Download references

Declarations

Publication costs for this article were funded by the corresponding author's institution.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Mark P Plummer.

Additional information

Competing interests

The authors declare that they have no competing interests.

Authors’ original submitted files for images

Below are the links to the authors’ original submitted files for images.

Authors’ original file for figure 1

Rights and permissions

Reprints and permissions

About this article

Cite this article

Plummer, M.P., Blaser, A.R. & Deane, A.M. Stress ulceration: prevalence, pathology and association with adverse outcomes. Crit Care 18, 213 (2014). https://doi.org/10.1186/cc13780

Download citation

  • Published:

  • DOI: https://doi.org/10.1186/cc13780

Keywords

Navigation