Intensive Care Medicine

, Volume 5, Issue 1, pp 1–4 | Cite as

Acute gastro-intestinal bleeding in the critically ill patient

  • J. R. Croker
Editorial

Summary

Endoscopic studies have shown that all critically ill patients are liable to a degree of stress ulceration. Diffuse erosions appear first in the fundus and then spread to the corpus and antrum within 48 h. Duodenal disease is particuarly common in burns patients. Discrete ulceration occurs in most severely injured patients. Mucosal damage is probably initiated by ischaemia but only develops in the presence of acid.

Although related to the severity of underlying illness, haemorrhage is unpredictable. Mortality is high and largely unaffected by treatment. Emphasis should therefore be made on prophylaxis. Improved intensive reducing intra-luminal acid by antacid or H2 receptor antagonists appears to be the most effective measure, but controlled studies are required.

This is a preview of subscription content, log in to check access.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Byrne, J. J., Guardione, V. A.: Surgical treatment of stress ulcers. Am. J. Surg.125, 464 (1973)Google Scholar
  2. 2.
    Czaja, A. J., McAlhany, J. C., Pruitt, B. A.: Acute gastroduodenal disease after thermal injury. N. Engl. J. Med.291, 925, (1974)Google Scholar
  3. 3.
    Czaja, A. J., McAlhany, J. C., Andes, W. A., Pruitt, B. A.: Acute gastric disease after cutaneous thermal injury. Arch. Surg.110, 600 (1975)Google Scholar
  4. 4.
    Czaja, A. J., McAlhany, J. C., Pruitt, B. A.: Pathogenesis of acute duodenal disease after burns — Role of acid secretion. Gastroenterology68, 1 (1975)Google Scholar
  5. 5.
    Davenport, H. W.: Gastric mucosal haemorrhage in dogs. Gastroenterology56, 439 (1969)Google Scholar
  6. 6.
    Fogelman, M. J., Garvey, J. M.: Acute gastro-duodenal ulceration incident to surgery and disease. Am J. Surg.112, 651 (1966)Google Scholar
  7. 7.
    French, J. D., Porter, R. W., Von Amerongen, F. K., Raney, R. B.: Gastro-intestinal-haemorrhage and ulceration associated with intracranial lesions. Surgery32, 395 (1952)Google Scholar
  8. 8.
    Fruhmorgen, P., Bodem, F., Reidenbach, H. D., et al.: Endoscopic laser coagulation of bleeding gastrointestinal lesions with report of the first therapeutic application in man. Gastrointest. Endos.23, 73 (1976)Google Scholar
  9. 9.
    Hastings, P. R., Skillman, J. J., Bushnell, L. S., Silen, W.: Antacid titration in the prevention of acute gastrointestinal bleeding. N. Engl. J. Med.298, 1041 (1978)Google Scholar
  10. 10.
    Jama, R. H., Perlman, M. H., Matsumoto, T.: Incidence of stress ulcer formation associated with steroid therapy in various shock states. Am. J. Surg.130, 328 (1975)Google Scholar
  11. 11.
    Kamada, T., Fusamoto, H., Kawano, S., et al.: Acute gastroduodenal lesions in head injury. Am. J. Gastroenterology68, 249 (1977)Google Scholar
  12. 12.
    Kiefhaber, P., Nath, G., Monitz, K.: Endoscopic control of massive gastro-intestinal hemorrhage by irradiation with a high power. Neodymium — Yag laser. Prog. Surg.15, 140 (1977)Google Scholar
  13. 13.
    Lewis, F. A.: Gastro-duodenal ulceration and haemorrhage of neurogenic origin. Br. J. Surg.69, 279 (1973)Google Scholar
  14. 14.
    Lucas, C. E., Sugawa, C., Riddle, J., et al.: Natural history and surgical dilemma of “Stress” gastric bleeding. Arch. Surg.102, 266 (1971)Google Scholar
  15. 15.
    Lucas, C. E., Sugawa, C., Friend, W., Walt, A. J.: Therapeutic implications of disturbed gastric physiology in patients with stress ulceration. Am. J. Surg.123, 25 (1972)Google Scholar
  16. 16.
    MacDonald, A. S., Pyne, D. A., Freeman, A., et al.: Upper gastrointestinal bleeding in the intensive care unit. Can. J. Surg.21, 81 (1978)Google Scholar
  17. 17.
    MacDonald, B. R. D., Bailey, R. J., Williams, R.: H2 —Receptor antagonists and antacids in the prevention of acute gastrointestinal haemorrhage in fulminant hepatic failure. Lancet1, 617 (1977)Google Scholar
  18. 18.
    McAlhany, J. C., Czaja, A. J., Pruitt, B. A.: Antacid control of complications from acute gastro-duodenal disease after burns. J. Trauma16, 645 (1976)Google Scholar
  19. 19.
    Moody, F. G., Aldrette, J. S.: Hydrogen permeability of canine gastric secretory epithelium during formation of acute superficial erosions. Surgery70, 154 (1971)Google Scholar
  20. 20.
    Norton, L., Greer, J., Eiseman, B.: Gastric secretory response to head injury. Arch. Surg.101, 200 (1970)Google Scholar
  21. 21.
    Pruitt B. A., Foley, E. D., Moncrief, J. A.: Curling's ulcer —A clinico-pathological study of 323 cases. Ann. Surg.172, 523 (1970)Google Scholar
  22. 22.
    Richardson, J. D., Bradley, J.: Gastric devascularization: A useful salvage procedure for massive hemorrhagic gastritis. Ann. Surg.185, 649 (1977)Google Scholar
  23. 23.
    Simonian, S. J., Curtis, L. E.: Treatment of haemorrhagic gastritis by antacid. Ann. Surg.184, 429 (1976)Google Scholar
  24. 24.
    Skillman, J. J., Gould, S. A., Chung, R. S. K., Silen, W.: The gastric mucosal barrier. Ann. Surg.172, 564 (1970)Google Scholar
  25. 25.
    Stremple, J. F., Mori, H., Lev, R., Glass, G. B. J.: The stress ulcer syndrome. Curr. Probl. Surg., April, 36, (1973)Google Scholar
  26. 26.
    Sugawa, C., Lucas, C. E., Rosenburg, B. F., et al.: Differential topography of acute erosive gastritis due to trauma or sepsis, ethanol and aspirin. Gastrointest. Endos.19, 127, (1973)Google Scholar
  27. 27.
    Watts, C. C., Clark, K.: Gastric acidity in the comatose patient. J. Neurosurg.30, 107 (1969)Google Scholar
  28. 28.
    Watts, C. C., Clark, K.: Effects of an anticholinergic drug on gastric acid secretion in the comatose patient. Surg. Gynec. Obstet.130, 61 (1970)Google Scholar

Copyright information

© Springer-Verlag 1979

Authors and Affiliations

  • J. R. Croker
    • 1
  1. 1.The Middlesex HospitalLondonEngland

Personalised recommendations