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Conservative treatment of stress ulcer bleeding: a new approach
Insights
Severe stress-induced bleeding, often from hemorrhagic gastritis, can be effectively treated with continuous ice-cold gastric lavage and sucralfate. This conservative approach successfully avoided surgery in all 23 patients studied.
Area of Science:
- Gastroenterology
- Critical Care Medicine
Background:
- Stress ulcer prophylaxis is imperfect, leaving patients vulnerable to severe bleeding, primarily from hemorrhagic gastritis.
- Existing treatments for stress-induced bleeding, including acid suppression and splanchnic blood flow reduction, are ineffective in a significant portion of intensive care unit patients.
- Total gastrectomy has been the last resort for refractory cases of severe stress-induced bleeding.
Observation:
- A novel conservative treatment strategy was employed for severe stress-induced hemorrhagic gastritis unresponsive to standard therapies (H2-receptor antagonists, pirenzepine, somatostatin).
- The regimen involved continuous gastric lavage with ice-cold Ringer's solution until bleeding ceased, followed by intensive sucralfate administration via gastric tube.
- This treatment was utilized as a final option in four patients already slated for total gastrectomy.
Findings:
- Twenty-three patients with severe stress-induced hemorrhagic gastritis were treated over seven years.
- All patients successfully responded to the combined therapy of ice-cold gastric lavage and sucralfate.
- No patient required surgical intervention, including those who were previously candidates for total gastrectomy.
Implications:
- This conservative management approach offers a viable alternative to total gastrectomy for severe stress-induced hemorrhagic gastritis.
- The findings suggest that continuous ice-cold gastric lavage and sucralfate can be highly effective in controlling and healing this critical condition.
- Further research may validate this protocol as a standard treatment, improving outcomes and reducing the need for radical surgery in intensive care settings.
Abstract:
Stress ulcer prophylaxis diminishes but does not eliminate the risk of severe bleeding from this complication. In 70-80% of the cases the source of bleeding is hemorrhagic gastritis. No controlled studies exist which have in particular investigated conservative therapy in patients with stress-induced hemorrhage. Even effective measures to suppress gastric acid secretion or to reduce splanchnic blood flow are ineffective in 10-40% of intensive care unit patients with stress-induced bleeding. In these cases total gastrectomy has so far often been the only therapeutic approach. We report our experience with a new approach in treating severe stress-induced hemorrhagic gastritis after ineffective primary treatment with H2-receptor antagonists, pirenzepine and somatostatin. Continuous gastric lavage with 5-10 l ice-cold Ringer's solution was used until complete cessation of bleeding, as evident from clear lavage. Repeated administration of 12 g sucralfate (60 ml) at 2-h intervals for 24 h through a gastric tube was used to prevent recurrence of bleeding and to promote healing. Sucralfate was reduced on the 2nd and 3rd day to 20 ml 2-hourly and later to 10 ml 4-hourly. In four patients this treatment was used as an ultima ratio when the patients were already scheduled for total gastrectomy. A total of 23 patients were treated during a 7-year period; all of them responded successfully, and no patient required surgery.