Prophylaxis for stress ulcer bleeding in the intensive care unit
Background: The critically ill patient can develop gastric erosions and, on occasion, stress ulcers with severe gastrointestinal bleeding that can be fatal. Aims: The purpose of this review was to provide current information on the pathophysiology, risk factors, and prophylaxis of digestive tract bl...
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doaj-483ad24a4ca94f3fb1ea3b9a1ad027bc2020-11-24T22:49:12ZengElsevierRevista de Gastroenterología de México (English Edition)2255-534X2014-01-01791505510.1016/j.rgmxen.2013.05.001Prophylaxis for stress ulcer bleeding in the intensive care unitJ.M. Avendaño-Reyes0H. Jaramillo-Ramírez1Servicio de Endoscopia Digestiva, Hospital General de Mexicali ISESALUD, Mexicali B.C., MexicoServicio de Medicina Interna, Hospital General de Mexicali ISESALUD, Mexicali B. C., MexicoBackground: The critically ill patient can develop gastric erosions and, on occasion, stress ulcers with severe gastrointestinal bleeding that can be fatal. Aims: The purpose of this review was to provide current information on the pathophysiology, risk factors, and prophylaxis of digestive tract bleeding from stress ulcers in the intensive care unit. Methods: We identified articles through a PubMed search, covering the years 1970 to 2013. The most relevant articles were selected using the search phrases “stress ulcer”, “stress ulcer bleeding prophylaxis”, and “stress-related mucosal bleeding” in combination with “intensive care unit”. Results: The incidence of clinically significant bleeding has decreased dramatically since 1980. The most important risk factors are respiratory failure and coagulopathy. Proton pump inhibitors (PPIs) or H2 receptor antagonists (H2RAs) are used in stress ulcer bleeding prophylaxis. Both drugs have been shown to be superior to placebo in reducing the risk for gastrointestinal bleeding and PPIs are at least as effective as H2RAs. Early enteral feeding has been shown to reduce the risk for stress ulcer bleeding, albeit in retrospective studies. Conclusions: Admittance to the intensive care unit in itself does not justify prophylaxis. PPIs are at least as effective as H2RAs. We should individualize the treatment of each patient in the intensive care unit, determining risk and evaluating the need to begin prophylaxis.http://www.sciencedirect.com/science/article/pii/S2255534X14000334Stress ulcer bleedingIntensive care unitProton pump inhibitorH2 receptor antagonistsMexico |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
J.M. Avendaño-Reyes H. Jaramillo-Ramírez |
spellingShingle |
J.M. Avendaño-Reyes H. Jaramillo-Ramírez Prophylaxis for stress ulcer bleeding in the intensive care unit Revista de Gastroenterología de México (English Edition) Stress ulcer bleeding Intensive care unit Proton pump inhibitor H2 receptor antagonists Mexico |
author_facet |
J.M. Avendaño-Reyes H. Jaramillo-Ramírez |
author_sort |
J.M. Avendaño-Reyes |
title |
Prophylaxis for stress ulcer bleeding in the intensive care unit |
title_short |
Prophylaxis for stress ulcer bleeding in the intensive care unit |
title_full |
Prophylaxis for stress ulcer bleeding in the intensive care unit |
title_fullStr |
Prophylaxis for stress ulcer bleeding in the intensive care unit |
title_full_unstemmed |
Prophylaxis for stress ulcer bleeding in the intensive care unit |
title_sort |
prophylaxis for stress ulcer bleeding in the intensive care unit |
publisher |
Elsevier |
series |
Revista de Gastroenterología de México (English Edition) |
issn |
2255-534X |
publishDate |
2014-01-01 |
description |
Background: The critically ill patient can develop gastric erosions and, on occasion, stress ulcers with severe gastrointestinal bleeding that can be fatal.
Aims: The purpose of this review was to provide current information on the pathophysiology, risk factors, and prophylaxis of digestive tract bleeding from stress ulcers in the intensive care unit.
Methods: We identified articles through a PubMed search, covering the years 1970 to 2013. The most relevant articles were selected using the search phrases “stress ulcer”, “stress ulcer bleeding prophylaxis”, and “stress-related mucosal bleeding” in combination with “intensive care unit”.
Results: The incidence of clinically significant bleeding has decreased dramatically since 1980. The most important risk factors are respiratory failure and coagulopathy. Proton pump inhibitors (PPIs) or H2 receptor antagonists (H2RAs) are used in stress ulcer bleeding prophylaxis. Both drugs have been shown to be superior to placebo in reducing the risk for gastrointestinal bleeding and PPIs are at least as effective as H2RAs. Early enteral feeding has been shown to reduce the risk for stress ulcer bleeding, albeit in retrospective studies.
Conclusions: Admittance to the intensive care unit in itself does not justify prophylaxis. PPIs are at least as effective as H2RAs. We should individualize the treatment of each patient in the intensive care unit, determining risk and evaluating the need to begin prophylaxis. |
topic |
Stress ulcer bleeding Intensive care unit Proton pump inhibitor H2 receptor antagonists Mexico |
url |
http://www.sciencedirect.com/science/article/pii/S2255534X14000334 |
work_keys_str_mv |
AT jmavendanoreyes prophylaxisforstressulcerbleedingintheintensivecareunit AT hjaramilloramirez prophylaxisforstressulcerbleedingintheintensivecareunit |
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1725676837110022144 |