Stress Ulcer Prophylaxis: A Practical Approach

Abstract

Although the incidence of bleeding from stress ulceration has declined over the last two decades, this condition remains of both clinical and economic importance. Recent studies suggest that stress ulcer prophylaxis is only indicated in high‐risk patients, most notably those patients undergoing mechanical ventilation and patients with a coagulopathy. There is little evidence that antacids, sucralfate, and H2 blockers differ with respect to the prevention of clinically important bleeding. The choice of agents is therefore largely determined by economic factors and the risk of drug‐associated complications.

Management of Head Trauma

“…125 Erosive GI lesions are common after severe head injury; therefore, routine stress ulcer prophylaxis is required. 126 Seizure prophylaxis is currently recommended for 7 days following the injury in patients with severe TBI. 127 The agent most commonly recommended is phenytoin, with a loading dose of 18 mg/kg and usual maintenance dose of 5 mg/kg/d following serum drug levels to a goal of 10 to 20 mg/L.…”

Prophylactic ranitidine treatment in critically ill children – a population pharmacokinetic study

“…A gastric pH below 2.5 is one of the risk factors for development of stress ulcers and gastrointestinal bleeding . Ranitidine is therefore prescribed routinely in paediatric intensive care units for prevention of stress ulcers and to negate harmful effects of GOR/gastric aspiration or the erosive side‐effects of certain drugs (e.g. corticosteroids).…”

Stress Ulcer Prophylaxis in the ICU: How Much Is Enough?

“… Stress ulcers of the gastrointestinal mucosa have been shown to develop in nearly all types of critically ill patients and endoscopic studies have shown mucosal abnormalities in the majority of patients [1]. As pointed out by Dr Marik in his article in this issue of the Journal of Intensive Care Medicine , the majority of patients do not manifest clinically important bleeding from gastrointestinal stress ulceration [2]. In fact, the incidence of clinically important bleeding from stress ulcers appears to have declined in recent years [3].…”