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Stressulkusprophylaxe

Stress ulcer prophylaxis

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Der Gastroenterologe Aims and scope

Zusammenfassung

Eine medikamentöse Stressulkusprophylaxe ist fester Bestandteil der Therapie auf konservativen und operativen Intensivstationen. Blutungen aus stressbedingten Läsionen im oberen Gastrointestinaltrakt sind selten, aber dann mit einer wesentlich schlechteren Prognose vergesellschaftet. Gesicherte Indikationen zur Durchführung sind das respiratorische Versagen mit der Notwendigkeit der Durchführung einer invasiven Beatmung über einen Zeitraum von mehr als 48 h und die Koagulopathie. Auch die aktuellen Sepsisleitlinien und die Leitlinie bezüglich des infarktbedingten kardiogenen Schockes empfehlen die Durchführung. Ob eine alleinige enterale Ernährung zur Stressulkusprophylaxe ausreicht, kann nicht beantwortet werden, eine frühe enterale Ernährung hat aber auch hier einen hohen Stellenwert. Eine medikamentöse Stressulkusprophylaxe auf Normalstation ist nicht indiziert. Zur medikamentösen Stressulkusprophylaxe stehen überwiegend Protonenpumpenhemmer und H2-Rezeptor-Antagonisten zur Verfügung. Aufgrund des etwas günstigeren Nebenwirkungsprofils und der wohl ausreichenden Wirkung zumindest in der Prävention stressbedingter Ulzera sind H2-Rezeptor-Antagonisten zu bevorzugen. In der Therapie stressbedingter Ulzerationen spielen sie keine Rolle.

Abstract

Pharmaceutical prophylaxis of stress ulcers is an integral part of therapy on conservative and surgical intensive care units. Bleeding from stress-induced lesions in the upper gastrointestinal tract is rare but when it occurs it is associated with a significantly worse prognosis. Established indications for the implementation of therapy are respiratory failure with the need for invasive ventilation over a period of more than 48 h and coagulopathy. The current guidelines on sepsis and the guidelines on infarction-induced cardiogenic shock also recommend the implementation. Whether enteral nutrition alone is sufficient prophylaxis for stress ulcers cannot be answered, but early enteral nutrition is also of great importance for this reason. Pharmaceutical prophylaxis of stress ulcers is not indicated outside the intensive care unit (ICU). For pharmaceutical prophylaxis of stress ulcers proton pump inhibitors (PPI) and H2 receptor antagonists (H2-RA) are also available. Due to the slightly more favorable adverse effects profile and probably sufficient effectiveness, H2-RAs should be given priority, at least in the prevention of stress-induced ulcers. Stress-induced ulcers have to be treated with PPI.

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Einhaltung der ethischen Richtlinien

Interessenkonflikt. G. Braun und H. Messmann geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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  1. III. Medizinische Klinik, Klinikum Augsburg, Stenglinstr. 2, 86156, Augsburg, Deutschland

    G. Braun & H. Messmann

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  1. G. Braun
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  2. H. Messmann
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Correspondence to G. Braun.

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Braun, G., Messmann, H. Stressulkusprophylaxe. Gastroenterologe 9, 535–540 (2014). https://doi.org/10.1007/s11377-014-0914-3

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