[Prophylaxis for stress ulcer bleeding in the intensive care unit]
J M Avendaño-Reyes1, H Jaramillo-Ramírez2
1Servicio de Endoscopia Digestiva, Hospital General de Mexicali ISESALUD, Mexicali B.C., México.
Revista De Gastroenterologia De Mexico
|March 18, 2014
Summary
Critically ill patients may develop stress ulcers and fatal gastrointestinal bleeding. Prophylaxis with proton pump inhibitors (PPIs) or H2 receptor antagonists (H2RAs) is effective, but treatment should be individualized based on patient risk factors.
Area of Science:
- Gastroenterology
- Critical Care Medicine
- Pharmacology
Context:
- Critically ill patients are at risk for stress ulcers and potentially fatal gastrointestinal bleeding.
- The incidence of clinically significant bleeding from stress ulcers has decreased significantly since 1980.
- Key risk factors include respiratory failure and coagulopathy.
Purpose:
- To review current information on the pathophysiology, risk factors, and prophylaxis of stress ulcer-related gastrointestinal bleeding in intensive care units.
- To synthesize evidence on the efficacy of different prophylactic agents and interventions.
Summary:
- Proton pump inhibitors (PPIs) and H2 receptor antagonists (H2RAs) are effective in preventing stress ulcer bleeding, with PPIs being at least as effective as H2RAs.
- Early enteral feeding may reduce the risk of stress ulcer bleeding.
- Prophylaxis is not universally indicated and should be based on individual patient risk assessment.
Impact:
- Informs clinical decision-making regarding stress ulcer prophylaxis in intensive care settings.
- Highlights the importance of individualized treatment strategies.
- Contributes to reducing morbidity and mortality associated with gastrointestinal bleeding in critically ill patients.
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