Acid suppression in critically ill patients: what does the evidence support?
Stress-related mucosal disease is a frequent complication in critically ill patients. A wealth of evidence suggests that hypoperfusion to the upper gastrointestinal tract can lead to ulceration and is associated with increased morbidity. Management of stress ulcers depends on aggressive therapy that includes acid-suppressive agents. Proton pump inhibitors (PPIs) have gained recognition as a potentially important therapy for treatment and prevention of upper gastrointestinal bleeding in critically ill patients. Patients who present to the hospital with acute gastrointestinal bleeding benefit from potent acid inhibition. Whereas histamine2-receptor antagonists have questionable efficacy in preventing ulcer rebleeding in this patient population, PPIs are highly effective. They should be considered first-line therapy for patients undergoing endoscopic hemostasis and for those with stigmata of upper gastrointestinal bleeding.
Division of Gastroenterology, University of California at Los Angeles School of Medicine, Los Angeles, California, USA. mjs5856@pol.net
Mitchell J
MJ
Spirt
D000284:Administration, Oral; D000863:Antacids / Q000627:therapeutic use; D000897:Anti-Ulcer Agents / Q000627:therapeutic use*; D002986:Clinical Trials as Topic; D016638:Critical Illness; D005744:Gastric Acid / Q000378:metabolism*; D006471:Gastrointestinal Hemorrhage / Q000188:drug therapy / Q000517:prevention & control; D006635:Histamine H2 Antagonists / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D007275:Injections, Intravenous; D010437:Peptic Ulcer / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control; D054328:Proton Pump Inhibitors; D013312:Stress, Physiological / Q000150:complications
D000863:Antacids; D000897:Anti-Ulcer Agents; D006635:Histamine H2 Antagonists; D054328:Proton Pump Inhibitors