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Acid suppression in critically ill patients: what does the evidence support?
1Division of Gastroenterology, University of California at Los Angeles School of Medicine, Los Angeles, California, USA. mjs5856@pol.net
Pharmacotherapy
|November 1, 2003
Summary
Proton pump inhibitors (PPIs) are highly effective for preventing and treating upper gastrointestinal bleeding in critically ill patients. They are recommended as first-line therapy over histamine2-receptor antagonists for patients with bleeding ulcers.
Area of Science:
- Critical Care Medicine
- Gastroenterology
- Pharmacology
Background:
- Stress-related mucosal disease is common in critically ill patients.
- Upper gastrointestinal tract hypoperfusion can cause ulceration and increase morbidity.
- Acid-suppressive agents are crucial for managing stress ulcers.
Purpose of the Study:
- To evaluate the efficacy of proton pump inhibitors (PPIs) in critically ill patients with upper gastrointestinal bleeding.
- To compare PPIs with histamine2-receptor antagonists for preventing ulcer rebleeding.
Main Methods:
- Review of evidence regarding acid-suppressive therapy in critically ill patients.
- Analysis of clinical outcomes associated with PPIs and histamine2-receptor antagonists.
Main Results:
- Proton pump inhibitors (PPIs) demonstrate high efficacy in treating and preventing upper gastrointestinal bleeding.
- Histamine2-receptor antagonists show questionable efficacy in preventing ulcer rebleeding in this population.
- Potent acid inhibition is beneficial for patients with acute gastrointestinal bleeding.
Conclusions:
- Proton pump inhibitors (PPIs) should be considered first-line therapy for critically ill patients with upper gastrointestinal bleeding.
- PPIs are recommended for patients undergoing endoscopic hemostasis or showing stigmata of bleeding.
- Effective acid inhibition is key in managing stress ulcer complications.