Stress Gastritis and Stress Ulcers: Prevention and Treatment

Chapter

Abstract

Critically ill patients, especially those with multisystem trauma, traumatic brain injury, respiratory failure, and severe burns, are at increased risk for stress gastritis and stress ulcers. Routine pharmacologic prophylaxis against stress-related gastrointestinal mucosal injury has dramatically decreased the incidence of life-threatening hemorrhage due to these diseases. However, prophylactic regimens may increase rates of other complications, including Clostridium difficile colitis, ventilator-associated pneumonia, and complex drug interactions. Therefore, widespread use of stress ulcer prophylaxis in critically ill patients must be balanced with the risks of its administration, and evolving ICU practices like early enteral nutrition that may decrease the rates of mucosal injury must be considered. This chapter reviews the epidemiology and pathophysiology of stress gastropathy in ICU patients, discusses stress ulcer prophylaxis regimens and reviews existing guideline recommendations for their appropriate use, and provides advice for the timely diagnosis and multimodal treatment of clinically significant GI bleeding due to stress gastropathy.

Keywords

Stress ulceration Gastritis Gastropathy Intensive care unit 

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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of SurgeryJohns Hopkins University School of MedicineBaltimoreUSA

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