Abstract
Stress-related mucosal disease (SRMD) is known to occur in critically ill patients both in the adult and paediatric population. Acute appendicitis is the most common surgical emergency in childhood and can precipitate SRMD. This possibility should be kept in mind, particularly in prolonged, complicated episodes. Although clinical complications of SRMD are rare, they may be highly significant in terms of haemorrhage or perforation and result in considerable morbidity or mortality. We provide a thorough review of the incidence, aetiology, role of Helicobacter pylori, risk factors, prophylaxis and management of this condition and describe a series of three cases of ulcerative SRMD in children with complicated appendicitis.
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References
Fennerty MD (2002) Pathophysiology of the upper gastrointestinal tract in the critically ill patient: rationale for the therapeutic benefits of acid suppression. Crit Care Med 30(Suppl 6):S351–S355
Cook DJ, Fuller HD, Guyatt GH, Marshall JC, Leasa D, Hall R, Winton TL, Rutledge F, Todd TJ, Roy P et al (1994) Risk factors for gastrointestinal bleeding in critically ill patients. Canadian Critical Care Trials Group. N Engl J Med 330(6):377–381
Toubanakis G (1988) Perforated chronic duodenal ulcer in children with coexistence of acute appendicitis. Aust Paediatr J 24(6):371–372
Agarwal HS, Churchwell KB, Pietsch JB, Little CA (2006) Hemorrhagic stress ulceration in a case of appendicitis. J Pediatr Surg 41(8):1483–1485
Bevacqua J (2006) Unhappy after an appendectomy. Gastric ulcer. J Pediatr Health Care 20(3):208–209. 223–225
Chaibou M, Tucci M, Dugas MA, Farrell CA, Proulx F, Lacroix J (1998) Clinically significant upper gastrointestinal bleeding acquired in a pediatric intensive care unit: a prospective study. Pediatrics 102(4 Pt 1):933–938
Lacroix J, Nadeau D, Laberge S, Gauthier M, Lapierre G, Farrell CA (1992) Frequency of upper gastrointestinal bleeding in a pediatric intensive care unit. Crit Care Med 20(1):35–42
Daley RJ, Rebuck JA, Welage LS, Rogers FB (2004) Prevention of stress ulceration: current trends in critical care. Crit Care Med 32(10):2008–2013
Maton PN (2005) Review article: prevention of stress-related mucosal bleeding with proton-pump inhibitors. Aliment Pharmacol Ther 22(Suppl. 3):45–52
Schilling D, Haisch G, Sloot N, Jakobs R, Saggau W, Riemann JF (2000) Low seroprevalence of Helicobacter pylori infection in patients with stress ulcer bleeding–a prospective evaluation of patients on a cardiosurgical intensive care unit. Intensive Care Med 26(12):1832–1836
Robert R, Gissot V, Pierrot M, Laksiri L, Mercier E, Prat G, Villers D, Vincent JF, Hira M, Vignon P, Charlot P, Burucoa C (2006) Helicobacter pylori infection is not associated with an increased hemorrhagic risk in patients in the intensive care unit. Critical Care 10(3):R77
Maury E, Tankovic J, Ebel A, Offenstadt G (2005) Parisian Group of the Upper Gastrointestinal Bleeding Survey. An observational study of upper gastrointestinal bleeding in intensive care units: is Helicobacter pylori the culprit? Crit Care Med 33(7):1513–1518
van der Voort PH, van der Hulst RW, Zandstra DF, Geraedts AA, van der Ende A, Tytgat GN (2001) Suppression of Helicobacter pylori infection during intensive care stay: related to stress ulcer bleeding incidence? J Crit Care 16(4):182–187
Pimentel M, Roberts DE, Bernstein CN, Hoppensack M, Duerksen DR (2000) Clinically significant gastrointestinal bleeding in critically ill patients in an era of prophylaxis. Am J Gastroenterol 95(10):2801–2806
Nithiwathanapong C, Reungrongrat S, Ukarapol N (2005) Prevalence and risk factors of stress-induced gastrointestinal bleeding in critically ill children. World J Gastroenterol 11(43):6839–6842
Cook DJ, Reeve BK, Guyatt GH, Heyland DK, Griffith LE, Buckingham L, Tryba M (1996) Stress ulcer prophylaxis in critically ill patients. Resolving discordant meta-analyses. JAMA 275(4):308–314
Messori A, Trippoli S, Vaiani M, Gorini M, Corrado A (2000) Bleeding and pneumonia in intensive care patients given ranitidine and sucralfate for prevention of stress ulcer: meta-analysis of randomised controlled trials. BMJ 321(7269):1103–1106
Behrens R, Hofbeck M, Singer H, Scharf J, Rupprecht T (1994) Frequency of stress lesions of the upper gastrointestinal tract in paediatric patients after cardiac surgery: effects of prophylaxis. Br Heart J 72(2):186–189
Cook DJ, Guyatt GH, Salena BJ, Laine LA (1992) Endoscopic therapy for acute nonvariceal upper gastrointestinal hemorrhage: a meta-analysis. Gastroenterology 102(1):139–148
Barkun A, Bardou M, Marshall JK (2003) Nonvariceal Upper GI Bleeding Consensus Conference Group. Consensus recommendations for managing patients with nonvariceal upper gastrointestinal bleeding. Ann Intern Med 139(10):843–857
Edwards MJ, Kollenberg SJ, Brandt ML, Wesson DE, Nuchtern JG, Minifee PK, Cass DL (2005) Surgery for peptic ulcer disease in children in the post-histamine2-blocker era. J Pediatr Surg 40(5):850–854
Azarow K, Kim P, Shandling B, Ein S (1996) A 45-year experience with surgical treatment of peptic ulcer disease in children. J Pediatr Surg 31(6):750–753
Morden RS, Schullinger JN, Mollitt DL, Santulli TV (1982) Operative management of stress ulcers in children. Ann Surg 196(1):18–20
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Lansdale, N., Hill, R., Hancock, S.W. et al. Stress-related mucosal disease in childhood appendicitis. Pediatr Surg Int 24, 1219–1222 (2008). https://doi.org/10.1007/s00383-008-2166-0
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DOI: https://doi.org/10.1007/s00383-008-2166-0