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Stress erosive gastritis
T A Miller1, M S Tornwall, F G Moody
1Department of Surgery, University of Texas Medical School, Houston.
Current Problems in Surgery
|July 1, 1991
Summary
Stress erosive gastritis bleeding is decreasing in critically ill patients due to better understanding and management of intragastric acidity and mucosal hypoperfusion. Aggressive medical treatment is effective, with surgery reserved for refractory cases, favoring a conservative approach.
Area of Science:
- Critical care medicine
- Gastroenterology
- Surgical gastroenterology
Background:
- Bleeding from stress erosive gastritis remains a concern in critically ill patients.
- Incidence has decreased due to improved understanding of pathophysiology.
- Key factors include intragastric acidity and gastric mucosal hypoperfusion.
Purpose of the Study:
- To review the current understanding and management of bleeding stress erosive gastritis.
- To highlight advancements in reducing intragastric acidity and treating shock.
- To discuss surgical options for refractory bleeding.
Main Methods:
- Review of pathophysiology of stress erosive gastritis.
- Evaluation of prophylactic measures, focusing on acid reduction (H2 receptor blockers).
- Assessment of medical and surgical management strategies for bleeding.
Main Results:
- Routine use of acid-reducing agents and improved shock management have decreased incidence.
- Over 80% of bleeding cases achieve cessation with aggressive medical management.
- No single surgical procedure is standard; conservative approaches are recommended.
Conclusions:
- Decreased incidence of bleeding stress erosive gastritis is linked to better pathophysiology understanding and management.
- H2 receptor blockers are effective for reducing intragastric acidity.
- For surgical cases, vagotomy and pyloroplasty with oversewing is a recommended conservative approach.