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Stress ulcer: is routine prophylaxis necessary?
1Gastroenterology and Critical Care Division, Baystate Medical Center, Springfield, Massachusetts, USA.
The American Journal of Gastroenterology
|May 1, 1995
Summary
Stress ulcer prophylaxis is not routinely recommended for critically ill patients. Pathogenesis has shifted to gastric ischemia, necessitating a review of bleeding mechanisms and prophylaxis strategies.
Area of Science:
- Critical care medicine
- Gastroenterology
- Pathophysiology
Background:
- Recent observations challenge the routine use of stress ulcer prophylaxis in critically ill patients.
- The understanding of stress ulcer pathogenesis has evolved from acid back-diffusion to gastric ischemia.
Purpose of the Study:
- To review the proposed mechanisms of stress ulcer bleeding.
- To discuss current prophylaxis strategies in light of new understanding.
Main Methods:
- Literature review of recent observations and proposed mechanisms.
- Synthesis of information on stress ulcer pathogenesis and prophylaxis.
Main Results:
- Stress ulcer bleeding is now understood to be primarily related to gastric ischemia rather than acid back-diffusion.
- Routine prophylaxis may not be indicated for all critically ill patients.
Conclusions:
- The shift in understanding necessitates re-evaluation of stress ulcer prophylaxis guidelines.
- Further research may be needed to refine prophylaxis strategies based on gastric ischemia.