Conservative treatment of stress ulcer bleeding: a new approach.
Stress ulcer prophylaxis diminishes but does not eliminate the risk of severe bleeding from this complication. In 70-80% of the cases the source of bleeding is hemorrhagic gastritis. No controlled studies exist which have in particular investigated conservative therapy in patients with stress-induced hemorrhage. Even effective measures to suppress gastric acid secretion or to reduce splanchnic blood flow are ineffective in 10-40% of intensive care unit patients with stress-induced bleeding. In these cases total gastrectomy has so far often been the only therapeutic approach. We report our experience with a new approach in treating severe stress-induced hemorrhagic gastritis after ineffective primary treatment with H2-receptor antagonists, pirenzepine and somatostatin. Continuous gastric lavage with 5-10 l ice-cold Ringer's solution was used until complete cessation of bleeding, as evident from clear lavage. Repeated administration of 12 g sucralfate (60 ml) at 2-h intervals for 24 h through a gastric tube was used to prevent recurrence of bleeding and to promote healing. Sucralfate was reduced on the 2nd and 3rd day to 20 ml 2-hourly and later to 10 ml 4-hourly. In four patients this treatment was used as an ultima ratio when the patients were already scheduled for total gastrectomy. A total of 23 patients were treated during a 7-year period; all of them responded successfully, and no patient required surgery.
Tryba
M
M
Dept. of Anesthesiology, University Hospital Bergmannsheil, Bochum, Germany.
May
B
B
D000328:Adult; D003422:Critical Care; D005260:Female; D005745:Gastric Acidity Determination; D005751:Gastric Lavage; D005765:Gastrointestinal Agents / Q000627:therapeutic use; D006801:Humans; D010438:Peptic Ulcer Hemorrhage / Q000175:diagnosis / Q000628:therapy*; D013276:Stomach Ulcer / Q000150:complications*; D013312:Stress, Physiological / Q000150:complications*
D005765:Gastrointestinal Agents