Stress ulcer bleeding

  • Richard F. Harty
  • Hari B. Ancha
Article

Opinion statement

Although upper gastrointestinal (GI) bleeding from stress-related mucosal disease (SRMD) in critically ill patients is common, significant bleeding with hemodynamic instability is not. Risk factor assessment can assist in identifying patients with a greater likelihood of developing significant SRMD. Prophylaxis against stress ulcer bleeding with luminal agents (eg, antacids and sucralfate) or drugs that inhibit acid secretion (eg, histamine 2-receptor antagonists [H2RAs] and proton-pump inhibitors [PPIs]) can reduce major bleeding but has little or no effect on mortality. Currently, the mainstays of prophylactic therapy for SRMD are intravenously administered H2RAs and PPIs. Wider usage of PPIs reflects their enhanced efficacy in suppressing acid secretion as well as lack of tolerance for H2RAs. Guidelines for the prophylactic use of H2RAs or PPIs in treatment of SRMD will require large, randomized studies that also examine cost effectiveness of individual strategies.

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Copyright information

© Current Science Inc 2006

Authors and Affiliations

  • Richard F. Harty
    • 1
  • Hari B. Ancha
  1. 1.Section of Gastroenterology, Department of MedicineOklahoma University Medical CenterOklahoma CityUSA

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