[Significance of upper gastrointestinal hemorrhage in patients with multiple injuries]

The incidence, time of onset and course of clinically manifest upper gastrointestinal bleeding was analysed in 265 polytraumatized patients with an average "injury severity score" (ISS) of 31.5. Under standardized intensive-care treatment - including appropriate artificial ventilation; maintenance of a stable circulation; complete parenteral and earliest possible enteral nutrition; low-dose heparinization; sedation and analgesia as required; and intragastric administration of antacids - only two patients (0.8%) had clinically manifest upper intestinal bleeding and then only preterminally in the course of incurable multi-organ involvement, the bleeding being a component of multiple organ failure. The focus of stress-ulcer prevention should lie in a decrease of factors precipitating multiple organ failure, as well as in the carefully selective use of general intensive-care measures. The need of general systemic prevention with H2-receptor blockers and (or) pirenzepine is questionable.