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Stress ulcers: current understanding of pathogenesis and prophylaxis
R L Kleiman1, C G Adair, K S Ephgrave
1Department of Clinical/Hospital Pharmacy, College of Pharmacy, University of Iowa, Iowa City 52242.
Drug Intelligence & Clinical Pharmacy
|June 1, 1988
Summary
Stress-related gastrointestinal bleeding is preventable with prophylaxis. Current treatments are unsatisfactory, highlighting the need for routine preventative measures in susceptible patients.
Area of Science:
- Gastroenterology
- Critical Care Medicine
Background:
- Stress-related gastrointestinal bleeding affects ~25% of critically ill patients.
- This condition is largely preventable with prophylaxis.
- Treatment of stress bleeding has high mortality and is often unsatisfactory.
Purpose of the Study:
- To review the literature on the development and prevention of stress ulcer disease.
- To highlight the importance of routine prophylaxis in susceptible patients.
Main Methods:
- Literature review of stress ulcer disease development and prevention.
- Analysis of contributing mechanisms to stress ulcer formation.
- Evaluation of current and alternative prophylactic agents.
Main Results:
- Mucosal ischemia and back-diffused hydrogen control are key mechanisms in stress ulcer formation.
- Antacids and histamine2-blockers are standard prophylaxis but may increase pneumonia risk.
- Alternative agents like sucralfate and prostaglandins are being investigated.
Conclusions:
- Routine prophylaxis for stress ulcer disease is crucial for susceptible patients.
- The limitations of current prophylactic agents necessitate research into alternatives.
- Preventing stress bleeding improves patient outcomes and reduces mortality.