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Related Experiment Videos

Stress-related mucosal damage: an overview.

D A Peura1

  • 1Division of Gastroenterology, Walter Reed Army Medical Center, Washington, D.C. 20307-5001.

The American Journal of Medicine
|December 18, 1987
PubMed
Summary

Critically ill patients often develop stress-related mucosal damage, increasing bleeding risk with disease severity. Effective management involves vigorous acid suppression to maintain intragastric pH control.

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Area of Science:

  • Gastroenterology
  • Critical Care Medicine
  • Pharmacology

Background:

  • Stress-related mucosal damage (SRMD) is common in critically ill patients.
  • The severity of underlying illness correlates with the risk of SRMD and gastrointestinal bleeding.
  • Poor prognosis is associated with severe gastric damage or bleeding.

Purpose of the Study:

  • To review the diagnosis and management of stress-related mucosal damage in critically ill patients.
  • To evaluate the efficacy of different treatment modalities for preventing bleeding.

Main Methods:

  • Endoscopy is the most sensitive diagnostic tool for SRMD.
  • Indicators include macroscopic bleeding, blood transfusion needs, and occult bleeding tests.
  • Gastric pH monitoring can indicate physiological stress response but doesn't always correlate with injury.

Main Results:

  • Vigorous acid suppression is crucial for treating SRMD and preventing bleeding.
  • Treatment options include antacids, histamine (H2)-receptor antagonists (e.g., cimetidine), and sucralfate.
  • Hourly antacids titrated to a target pH or continuous infusion of cimetidine are most effective for pH control.

Conclusions:

  • Effective intragastric pH control is essential for managing SRMD.
  • Antacids and cimetidine infusions are highly efficacious regimens.
  • Early diagnosis and management of SRMD are critical for improving patient outcomes.

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