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Acute Gastrointestinal Bleeding pp 57–74Cite as

Medical Therapy for Stress Ulcer Prophylaxis

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Part of the book series: Clinical Gastroenterology ((CG))

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
Full size table

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).

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Abbreviations

APACHE:

Acute Physiology and Chronic Health Evaluation

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Authors
  1. Robert S. Bresalier MD
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Editors and Affiliations

  1. Section of Gastroenterology, University of Chicago Hospitals, Chicago, IL, USA

    Karen E. Kim MD

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© 2003 Humana Press Inc., Totowa, NJ

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Bresalier, R.S. (2003). Medical Therapy for Stress Ulcer Prophylaxis. In: Kim, K.E. (eds) Acute Gastrointestinal Bleeding. Clinical Gastroenterology. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-59259-299-9_4

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  • DOI: https://doi.org/10.1007/978-1-59259-299-9_4

  • Publisher Name: Humana Press, Totowa, NJ

  • Print ISBN: 978-1-4684-9723-6

  • Online ISBN: 978-1-59259-299-9

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