Skip to main content

Stress Ulceration: Prevalence, Pathology and Association with Adverse Outcomes

  • Chapter
Book cover Annual Update in Intensive Care and Emergency Medicine 2014

Part of the book series: Annual Update in Intensive Care and Emergency Medicine ((AUICEM,volume 2014))

  • 2122 Accesses

Abstract

So-called ‘stress-related mucosal damage’ (SRMD) is the broad term used to describe the spectrum of pathology attributed to the acute, erosive, inflammatory insult to the upper gastrointestinal tract associated with critical illness [1]. SRMD represents a continuum from asymptomatic superficial lesions found incidentally during endoscopy, occult gastrointestinal bleeding causing anemia, overt gastrointestinal bleeding and clinically significant gastrointestinal bleeding.

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

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 119.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 159.00
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Peura D (1986) Stress-related mucosal damage. Clin Ther 8(A):14–23

    PubMed  Google Scholar 

  2. Skillman JJ, Bushnell LS, Goldman H, Silen W (1969) Respiratory failure, hypotension, sepsis, and jaundice. A clinical syndrome associated with lethal hemorrhage from acute stress ulceration of the stomach. Am J Surg 117:523–530

    Article  CAS  PubMed  Google Scholar 

  3. Mutlu GM, Mutlu EA, Factor P (2001) GI complications in patients receiving mechanical ventilation. Chest 119:1222–1241

    Article  CAS  PubMed  Google Scholar 

  4. Cook DJ, Fuller HD, Guyatt GH et al (1994) Risk factors for gastrointestinal bleeding in critically ill patients. Canadian Critical Care Trials Group. N Engl J Med 330:377–381

    Article  CAS  PubMed  Google Scholar 

  5. Hastings PR, Skillman JJ, Bushnell LS, Silen W (1978) Antacid Titration in the Prevention of Acute Gastrointestinal Bleeding. N Engl J Med 298:1041–1045

    Article  CAS  PubMed  Google Scholar 

  6. Alhazzani W, Alenezi F, Jaeschke RZ, Moayyedi P, Cook DJ (2013) Proton pump inhibitors versus histamine 2 receptor antagonists for stress ulcer prophylaxis in critically ill patients: a systematic review and meta-analysis. Crit Care Med 41:693–705

    Article  CAS  PubMed  Google Scholar 

  7. Faisy C, Guerot E, Diehl JL, Iftimovici E, Fagon JY (2003) Clinically significant gastrointestinal bleeding in critically ill patients with and without stress-ulcer prophylaxis. Intensive Care Med 29:1306–1313

    Article  PubMed  Google Scholar 

  8. Cook DJ, Griffith LE, Walter SD et al (2001) The attributable mortality and length of intensive care unit stay of clinically important gastrointestinal bleeding in critically ill patients. Crit Care 5:368–375

    Article  CAS  PubMed  Google Scholar 

  9. Marik PE, Vasu T, Hirani A, Pachinburavan M (2010) Stress ulcer prophylaxis in the new millennium: a systematic review and meta-analysis. Crit Care Med 38:2222–2228

    Article  PubMed  Google Scholar 

  10. Fiddian-Green RG, Mcgough E, Pittenger G, Rothman E (1983) Predictive value of intramural pH and other risk factors for massive bleeding from stress ulceration. Gastroenterology 85:613–620

    CAS  PubMed  Google Scholar 

  11. Vincent JL (2005) Give your patient a fast hug (at least) once a day. Crit Care Med 33:1225–1229

    Article  PubMed  Google Scholar 

  12. Dellinger RP, Levy MM, Rhodes A et al (2013) Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock: 2012. Crit Care Med 41:580–637

    Article  PubMed  Google Scholar 

  13. Cook DJ, Reeve BK, Guyatt GH et al (1996) Stress ulcer prophylaxis in critically ill patients. Resolving discordant meta-analyses. JAMA 275:308–314

    Article  CAS  PubMed  Google Scholar 

  14. Daley RJ, Rebuck JA, Welage LS, Rogers FB (2004) Prevention of stress ulceration: current trends in critical care. Crit Care Med 32:2008–2013

    Article  PubMed  Google Scholar 

  15. Guy C, Ollagnier M (1999) Sucralfate and bezoars: data from the system of pharmacologic vigilance and review of the literature. Therapie 54:55–58

    CAS  PubMed  Google Scholar 

  16. Netzer P, Gaia C, Sandoz M et al (1999) Effect of repeated injection and continuous infusion of omeprazole and ranitidine on intragastric pH over 72 hours. Am J Gastroenterol 94:351–357

    CAS  PubMed  Google Scholar 

  17. Powell H, Morgan M, Li SK, Baron J (1993) Inhibition of gastric acid secretion in the intensive care unit after coronary artery bypass graft. A pilot control study of intravenous omeprazole by bolus and infusion, ranitidine and placebo. Theor Surg 8:125–130

    Google Scholar 

  18. Risaliti ATG, Uzzau A (1993) Intravenous omeprazole vs ranitidine in the prophylaxis of stress ulcers. Acta. Chir Ital 49:397–401

    Google Scholar 

  19. Levy MJ, Seelig CB, Robinson NJ, Ranney JE (1997) Comparison of omeprazole and ranitidine for stress ulcer prophylaxis. Dig Dis Sci 42:1255–1259

    Article  CAS  PubMed  Google Scholar 

  20. Lasky MR, Metzler MH, Phillips JO (1998) A prospective study of omeprazole suspension to prevent clinically significant gastrointestinal bleeding from stress ulcers in mechanically ventilated trauma patients. J Trauma 44:527–533

    Article  CAS  PubMed  Google Scholar 

  21. Phillips JMM (1998) Multicenter prospective randomized clinical trial of continuous infusion I.V. Ranitidine vs. Omeprazole suspension in the prophylaxis of stress ulcers. Crit Care Med 26:101A

    Google Scholar 

  22. Azevedo SM Jr, Silva G, Palacio G (1999) Prevention of stress ulcer bleeding in high risk patients. Comparison of three drugs. Crit Care Med 27:A145

    Article  Google Scholar 

  23. Kantorova I, Svoboda P, Scheer P et al (2004) ulcer prophylaxis in critically ill patients: a randomized controlled trial. Hepatogastroenterology. Stress 51:757–761

    Google Scholar 

  24. Pan XZW, Li Z (2004) The preventive effects of rabeprazole on upper gastrointestinal tract hemorrhage in patients with severe acute pancreatitis. Chin. J Gastroenterol 9:30–32

    Google Scholar 

  25. Conrad SA, Gabrielli A, Margolis B et al (2005) Randomized, double-blind comparison of immediate-release omeprazole oral suspension versus intravenous cimetidine for the prevention of upper gastrointestinal bleeding in critically ill patients. Crit Care Med 33:760–765

    Article  CAS  PubMed  Google Scholar 

  26. Hata M, Shiono M, Sekino H et al (2005) Prospective randomized trial for optimal prophylactic treatment of the upper gastrointestinal complications after open heart surgery. Circ J 69:331–334

    Article  CAS  PubMed  Google Scholar 

  27. Kotlyanskaya A, Mukherji R et al (2008) A comparison of lansoprazole disintegrating tablet, lansoprazole suspension or ranitidine for stress ulcer prophylaxis in critically ill patients. Crit Care Med 7:A194 (abst)

    Google Scholar 

  28. Somberg L, Morris J Jr, Fantus R et al (2008) Intermittent intravenous pantoprazole and continuous cimetidine infusion: effect on gastric pH control in critically ill patients at risk of developing stress-related mucosal disease. J Trauma 64:1202–1210

    Article  CAS  PubMed  Google Scholar 

  29. Solouki MMS, Kouchak M (2009) Comparison between the preventive effects of ranitidine and omeprazole on upper gastrointestinal bleeding among ICU patients. Tanaffos 8:37–42

    Google Scholar 

  30. Heyland D, Bradley C, Mandell LA (1992) Effect of acidified enteral feedings on gastric colonization in the critically ill patient. Crit Care Med 20:1388–1394

    Article  CAS  PubMed  Google Scholar 

  31. Klompas M (2013) Complications of mechanical ventilation – the CDC's new surveillance paradigm. N Engl J Med 368:1472–1475

    Article  CAS  PubMed  Google Scholar 

  32. Chapman MJ, Nguyen NQ, Deane AM (2011) Gastrointestinal dysmotility: clinical consequences and management of the critically ill patient. Gastroenterol Clin North Am 40:725–739

    Article  PubMed  Google Scholar 

  33. Laheij RJ, Sturkenboom MC, Hassing RJ, Dieleman J, Stricker BH, Jansen JB (2004) Risk of community-acquired pneumonia and use of gastric acid-suppressive drugs. JAMA 292:1955–1960

    Article  CAS  PubMed  Google Scholar 

  34. Prod'hom G, Leuenberger P, Koerfer J et al (1994) Nosocomial pneumonia in mechanically ventilated patients receiving antacid, ranitidine, or sucralfate as prophylaxis for stress ulcer. A randomized controlled trial. Ann Intern Med 120:653–662

    Article  PubMed  Google Scholar 

  35. Heyland DK, Cook DJ, Schoenfeld PS, Frietag A, Varon J, Wood G (1999) The effect of acidified enteral feeds on gastric colonization in critically ill patients: results of a multicenter randomized trial. Canadian Critical Care Trials Group. Crit Care Med 27:2399–2406

    Article  CAS  PubMed  Google Scholar 

  36. Jacobs S, Chang RW, Lee B, Bartlett FW (1990) Continuous enteral feeding: a major cause of pneumonia among ventilated intensive care unit patients. JPEN J Parenter Enteral Nutr 14:353–356

    Article  CAS  PubMed  Google Scholar 

  37. Zilberberg MD, Nathanson BH, Sadigov S, Higgins TL, Kollef MH, Shorr AF (2009) Epidemiology and outcomes of clostridium difficile-associated disease among patients on prolonged acute mechanical ventilation. Chest 136:752–758

    PubMed  Google Scholar 

  38. Howell MD, Novack V, Grgurich P et al (2010) Iatrogenic gastric acid suppression and the risk of nosocomial Clostridium difficile infection. Arch Intern Med 170:784–790

    Article  PubMed  Google Scholar 

  39. Yearsley KA, Gilby LJ, Ramadas AV, Kubiak EM, Fone DL, Allison MC (2006) Proton pump inhibitor therapy is a risk factor for Clostridium difficile-associated diarrhoea. Aliment Pharmacol Ther 24:613–619

    Article  CAS  PubMed  Google Scholar 

  40. Khalili H, Huang ES, Jacobson BC, Camargo CA Jr, Feskanich D, Chan AT (2012) Use of proton pump inhibitors and risk of hip fracture in relation to dietary and lifestyle factors: a prospective cohort study. BMJ 344:e372

    Article  PubMed Central  PubMed  Google Scholar 

  41. Farley KJ, Barned KL, Crozier TM (2013) Inappropriate continuation of stress ulcer prophylaxis beyond the intensive care setting. Crit Care Resusc 15:147–151

    CAS  PubMed  Google Scholar 

  42. Deane AM, Dhaliwal R, Day AG, Ridley EJ, Davies AR, Heyland DK (2013) Comparisons between intragastric and small intestinal delivery of enteral nutrition in the critically ill: a systematic review and meta-analysis. Crit Care 17:R125

    Article  Google Scholar 

  43. Ephgrave KS, Kleiman-Wexler RL, Adair CG (1990) Enteral nutrients prevent stress ulceration and increase intragastric volume. Crit Care Med 18:621–624

    Article  CAS  PubMed  Google Scholar 

  44. Sim JA, Horowitz M, Summers MJ et al (2013) Mesenteric blood flow, glucose absorption and blood pressure responses to small intestinal glucose in critically ill patients older than 65 years. Intensive Care Med 39:258–266

    Article  PubMed  Google Scholar 

  45. Bonten MJ, Gaillard CA, Van Tiel FH, Van Der Geest S, Stobberingh EE (1994) Continuous enteral feeding counteracts preventive measures for gastric colonization in intensive care unit patients. Crit Care Med 22:939–944

    Article  CAS  PubMed  Google Scholar 

  46. Harju E, Sajanti J (1987) The protective effect of nutrients against stress induced gastric ulcers in the rat. Surg Gynecol Obstet 165:530–534

    CAS  PubMed  Google Scholar 

  47. Stollman N, Metz DC (2005) Pathophysiology and prophylaxis of stress ulcer in intensive care unit patients. J Crit Care 20:35–45

    Article  PubMed  Google Scholar 

  48. Ben-Menachem T, Mccarthy BD, Fogel R et al (1996) Prophylaxis for stress-related gastrointestinal hemorrhage: a cost effectiveness analysis. Crit Care Med 24:338–345

    Article  CAS  PubMed  Google Scholar 

  49. Devlin JW, Claire KS, Dulchavsky SA, Tyburski JG (1999) Impact of trauma stress ulcer prophylaxis guidelines on drug cost and frequency of major gastrointestinal bleeding. Pharmacotherapy 19:452–460

    Article  CAS  PubMed  Google Scholar 

  50. Cash BD (2002) Evidence-based medicine as it applies to acid suppression in the hospitalized patient. Crit Care Med 30:S373–S378

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to M. P. Plummer .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2014 Springer International Publishing Switzerland and BioMed Central Ltd.

About this chapter

Cite this chapter

Plummer, M.P., Reintam Blaser, A., Deane, A.M. (2014). Stress Ulceration: Prevalence, Pathology and Association with Adverse Outcomes. In: Vincent, JL. (eds) Annual Update in Intensive Care and Emergency Medicine 2014. Annual Update in Intensive Care and Emergency Medicine, vol 2014. Springer, Cham. https://doi.org/10.1007/978-3-319-03746-2_36

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-03746-2_36

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-03745-5

  • Online ISBN: 978-3-319-03746-2

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics