[Stress lesions in the upper gastrointestinal tract]

Clinically relevant bleeding in the upper gastrointestinal tract due to stress lesions is a rare event; however, the related mortality may be as high as 13% (van Leerdam, Best Pract Res Clin Gastroenterol 2008; 22:209-224). Most often affected are patients in the intensive care unit (ICU) with impaired perfusion as the protective pathways are critically dependent on a near normal blood flow. Minimal mucosal lesions with a tiny hemorrhage can escalate to severe bleeding as the coagulation potential in the presence of an acidic pH is clearly decreased. Mechanical ventilation and coagulopathy are recognized risk factors and these patients should receive an acid suppressing therapy. Proton pump inhibitors (PPI) and histamine type 2 receptor antagonists (H(2)RA) are equal in their ability to prevent stress-related bleeding. However, the side effects of PPI can cause severe morbidity and therefore H(2)RAs may be the drug of choice for prophylaxis. Endoscopy is recommended as a diagnostic and therapeutic tool for patients with active bleeding. Treatment with PPI in this scenario (before and after endoscopy) may reduce complications by leading to premature hemostasis and reduced recurrence of bleeding.