Occult upper gastrointestinal mucosal abnormalities in critically ill patients

Area of Science:

• Gastroenterology
• Critical Care Medicine
• Endoscopy

Background:

• Investigating occult upper gastrointestinal (GI) abnormalities in intensive care unit (ICU) patients.
• Assessing the role of gastric acid secretion in observed GI pathology.
• Determining associations between GI abnormalities and clinical outcomes.

Purpose of the Study:

• To estimate the frequency of occult upper GI abnormalities in ICU patients.
• To evaluate gastric acid as a potential contributing factor to these abnormalities.
• To examine the relationship between GI abnormalities and clinical outcomes such as mortality.

Main Methods:

• Retrospective analysis of endoscopy reports from 74 ICU patients undergoing endoscopy for research.
• Independent adjudication of endoscopic findings by two gastroenterologists.
• Assessment of gastric acid contribution using a 3-point scale.

Main Results:

• Occult abnormalities detected in 34% of patients, including gastritis/erosions and nasogastric tube trauma.
• Gastric acid contribution rated 'probable' in a small subset of patients.
• No association found between acid-suppressive therapy and endoscopic abnormalities (P=0.46).
• Mucosal abnormalities were not linked to hemoglobin levels, transfusion needs, or mortality (P>0.9).

Conclusions:

• One-third of ICU patients exhibit occult upper GI mucosal abnormalities.
• The presence of these abnormalities is not influenced by prior acid-suppressive therapy.
• Observed GI abnormalities did not correlate with adverse clinical outcomes in this cohort.