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Stress ulcer bleeding
Richard F Harty1, Hari B Ancha
1Department of Medicine, Oklahoma University Medical Center, Oklahoma City, OK 73104, USA. richard-harty@ouhsc.edu
Current Treatment Options in Gastroenterology
|March 17, 2006
Summary
Stress-related mucosal disease (SRMD) prophylaxis in critically ill patients can reduce bleeding but doesn't impact mortality. Proton-pump inhibitors (PPIs) are increasingly used over histamine 2-receptor antagonists (H2RAs) due to better efficacy and less tolerance. Further research is needed for optimal guidelines.
Area of Science:
- Critical Care Medicine
- Gastroenterology
- Pharmacology
Background:
- Stress-related mucosal disease (SRMD) is common in critically ill patients, but significant bleeding with hemodynamic instability is rare.
- Risk factor assessment aids in identifying patients at higher risk for SRMD.
Purpose of the Study:
- To review the current strategies for prophylaxis against upper gastrointestinal bleeding due to SRMD in critically ill patients.
- To compare the efficacy and usage trends of different prophylactic agents, particularly histamine 2-receptor antagonists (H2RAs) and proton-pump inhibitors (PPIs).
Main Methods:
- Review of existing literature on SRMD prophylaxis in critically ill patients.
- Analysis of the mechanisms and clinical outcomes associated with luminal agents, H2RAs, and PPIs.
Main Results:
- Prophylaxis reduces major bleeding but has minimal to no effect on mortality.
- Intravenously administered H2RAs and PPIs are the current mainstays for SRMD prophylaxis.
- PPIs are increasingly favored over H2RAs due to superior acid suppression and lack of tolerance.
Conclusions:
- While effective in reducing bleeding, current prophylactic strategies for SRMD do not improve mortality.
- Further large, randomized, cost-effectiveness studies are required to establish definitive guidelines for H2RA and PPI use in SRMD prophylaxis.