scholarly journals Upper Gastrointestinal Bleeding in Critically Ill Patient: Literature Review

2022 ◽  
Vol 22 (3) ◽  
pp. 226-233
Author(s):  
William Faisal ◽  
Luciana Rotty
Keyword(s):  
At Risk ◽  
Gastrointestinal Tract ◽  
Gastrointestinal Bleeding ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Stress Ulcer ◽  
Upper Gastrointestinal Tract ◽  
Stress Ulcers ◽  
Ulcer Prophylaxis ◽  
Upper Gastrointestinal

Critically ill patients are at risk for stress ulcers in the upper digestive tract. Various risk factors have been associated with this condition. Patients who are critically ill are at risk of bleeding due to stress related mucosal disease (SRMD). Upper gastrointestinal tract problems usually occur as a result of severe physiological stress. Patients may develop gastric erosion and develop stress ulcers with severe gastrointestinal bleeding which can be fatal. Routine pharmacological use of stress ulcer prophylaxis (SUP) does not reduce overall mortality in intensive care patients. This increases the risk of infectious complications, particularly nosocomial pneumonia and Clostridium difficile-associated diarrhea. Early enteral nutrition has been shown to be effective in preventing stress ulceration of the upper gastrointestinal tract in critically ill patients. Routine use of stress ulcer prophylaxis in all critically ill patients may be dangerous and does not appear to be cost-effective. SUP administration must follow an algorithm that clearly balances risks and benefits.

Clinically significant gastrointestinal bleeding in critically ill patients with and without stress-ulcer prophylaxis

2003 ◽  
Vol 29 (8) ◽  
pp. 1306-1313 ◽  
Author(s):  
Christophe Faisy ◽  
Emmanuel Guerot ◽  
Jean-Luc Diehl ◽  
Eléonore Iftimovici ◽  
Jean-Yves Fagon
Keyword(s):  
Gastrointestinal Bleeding ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Stress Ulcer ◽  
Stress Ulcer Prophylaxis ◽  
Clinically Significant ◽  
Ulcer Prophylaxis

scholarly journals Comparison of proton pump inhibitors and histamine 2 receptor antagonists for stress ulcer prophylaxis in the intensive care unit

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Myung Jin Song ◽  
Seok Kim ◽  
Dachung Boo ◽  
Changhyun Park ◽  
Sooyoung Yoo ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Adverse Events ◽  
Gastrointestinal Bleeding ◽  
Critically Ill ◽  
Proton Pump ◽  
Critically Ill Patients ◽  
Stress Ulcer ◽  
Stress Ulcer Prophylaxis ◽  
Ulcer Prophylaxis

AbstractProton pump inhibitors (PPIs), followed by histamine 2 receptor antagonists (H2RAs), are the most commonly used drugs to prevent gastrointestinal bleeding in critically ill patients through stress ulcer prophylaxis. The relative efficacy and drug-related adverse events of PPIs and H2RAs remain unclear. In this retrospective, observational, comparative cohort study, PPIs and H2RAs for stress ulcer prophylaxis in critically ill patients were compared using a common data model. After propensity matching, 935 patients from each treatment group (PPI or H2RA) were selected. The PPI group had a significantly higher 90-day mortality than the H2RA group (relative risk: 1.28; P = 0.01). However, no significant inter-group differences in the risk of clinically important gastrointestinal bleeding were observed. Moreover, there were no significant differences between the groups concerning the risk of pneumonia or Clostridioides difficile infection, which are known potential adverse events related to these drugs. Subgroup analysis of patients with high disease severity were consistent with those of the total propensity score-matched population. These findings do not support the current recommendations, which prefer PPIs for gastrointestinal bleeding prophylaxis in the intensive care unit.

scholarly journals The Use of Proton Pump Inhibitors in Intensive Care Units

2018 ◽  
Vol 0 (0) ◽  
Author(s):  
Aleksandar Cvetkovic ◽  
Marko Spasic ◽  
Mladen Pavlovic ◽  
Danijela Cvetkovic ◽  
Bojan Stojanovic ◽  
...  
Keyword(s):  
Intensive Care ◽  
Gastrointestinal Tract ◽  
Intensive Care Units ◽  
Critically Ill ◽  
Proton Pump Inhibitors ◽  
Proton Pump ◽  
Critically Ill Patients ◽  
Upper Gastrointestinal Tract ◽  
Gastrointestinal Tract Bleeding ◽  
Upper Gastrointestinal

AbstractThe bleeding from the upper gastrointestinal tract represent a significant medical but also socio-economic problem. A special group of patients et increased risk consists of critically ill patients in intensive care units. Particularly significant cause of bleeding in intensive care unit patients is bleeding resulting from the stress ulcers caused by damage of the mucosa of the stomach and duodenum.The purpose of this review is to present current experience in prevention of upper gastrointestinal tract bleeding using proton pump inhibitors in intensive care units.Combination of endoscopic hemostatic methods and proton pump inhibitors represents golden standard in most cases.Despite some adverse effects treatment with proton pump blockers is essential when upper gastrointestinal tract bleeding appears in critically ill patients in intensive care units. Proton pump inhibitors are more effective in acid suppression, as well as in the prevention of recurrent bleeding after endoscopic hemostasis than histamine 2 receptor blockers. The efficacy of proton pump blockers is higher in the case of a continuous intravenous infusion than in the intermittent mode of administration of the drug. The need for highly elaborate strategy for the prophylaxis of bleeding from the upper parts of gastrointestinal tract in intensive care units is essential, because when it occurs in intensive care units, mortality is high, and therapeutic options become narrow.

Famotidine Versus Pantoprazole for Preventing Bleeding in the Upper Gastrointestinal Tract of Critically Ill Patients Receiving Mechanical Ventilation

2008 ◽  
Vol 17 (2) ◽  
pp. 142-147 ◽  
Author(s):  
Kizito Ojiako ◽  
Hiren Shingala ◽  
Christa Schorr ◽  
David R. Gerber
Keyword(s):  
Mechanical Ventilation ◽  
Gastrointestinal Tract ◽  
Critically Ill ◽  
Proton Pump ◽  
Critically Ill Patients ◽  
Dialysis Patients ◽  
Stress Ulcers ◽  
Project Impact ◽  
Risk For Bleeding ◽  
Upper Gastrointestinal

Background Mechanical ventilation increases risk for bleeding in the upper part of the gastrointestinal tract. Proton pump inhibitors, although they are more potent and longer acting inhibitors of gastric acid production than are histamine2 antagonists, also are generally more expensive. Data comparing the 2 types of agents for preventing gastrointestinal bleeding in critically ill patients are limited. Objectives To compare the effectiveness of famotidine (a histamine2 antagonist) and pantoprazole (a proton pump inhibitor) in preventing stress ulcers in critically ill patients receiving mechanical ventilation. Methods Data were collected from the Project Impact database. All patients who received mechanical ventilation for more than 48 hours from November 2002 to June 2006 and were treated with either drug were included. Patients receiving other drugs or with known bleeding in the upper part of the gastrointestinal tract, thrombocytopenia, or coagulopathy were excluded. Results A total of 522 patients who received famotidine and 95 who received pantoprazole were included. Bleeding in the upper part of the gastrointestinal tract was more common in patients receiving pantoprazole than in patients receiving famotidine (0.38% vs 3.2%, P= .03). Although scores on the Acute Physiology and Chronic Health Evaluation II were higher in patients who received pantoprazole (P= .01), other outcome measures did not differ significantly between groups. Bleeding in the upper part of the gastrointestinal tract was more frequent among dialysis patients receiving pantoprazole than among those receiving famotidine. Conclusions Famotidine and pantoprazole are similarly effective for preventing bleeding in the upper part of the gastrointestinal tract in patients receiving mechanical ventilation.

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