Multimodal management of upper gastrointestinal bleeding caused by stress gastropathy

The 1999 ASHP (American Society of Health-System Pharmacists) recommendation regarding the prevention of stress-related mucosal disease and bleeding in critical care patients by using PPI and H2RA still holds. We tried to compare the results obtained by our group with the international data available and determine the benefits of this prophylactic therapy.

The present paper presents a retrospective single center report of 36 patients with upper gastrointestinal (GI) bleeding caused by stress gastritis. Despite prophylaxis, the patients included in this study who were admitted in the ICU during a five year period (2003-2008) with various underlying conditions, had clinical and endoscopic diagnoses of bleeding from stress-related gastric mucosal disease. The initial treatment focused on patient stabilization first by medical intervention aimed at maintaining an elevated intragastric pH, in association with haemostatic drugs and blood transfusions; complementary endoscopic or surgical haemostatic therapy was employed for patients unresponsive to the initial management.

Despite prophylactic acid suppressive therapy, upper GI bleeding findings were consistently present in high risk patients, 69.4% presenting hematemesis and 55.6% presenting coffee-ground gastric content.

Each institution needs to have guidelines in place to establish the patients that actually have sufficient risk factors to justify stress gastritis prophylaxis.