Multimodal management of upper gastrointestinal bleeding caused by stress gastropathy.
BACKGROUND
The 1999 ASHP (American Society of Health-System Pharmacists) recommendation regarding the prevention of stress-related mucosal disease and bleeding in critical care patients by using PPI and H2RA still holds. We tried to compare the results obtained by our group with the international data available and determine the benefits of this prophylactic therapy.


METHODS
The present paper presents a retrospective single center report of 36 patients with upper gastrointestinal (GI) bleeding caused by stress gastritis. Despite prophylaxis, the patients included in this study who were admitted in the ICU during a five year period (2003-2008) with various underlying conditions, had clinical and endoscopic diagnoses of bleeding from stress-related gastric mucosal disease. The initial treatment focused on patient stabilization first by medical intervention aimed at maintaining an elevated intragastric pH, in association with haemostatic drugs and blood transfusions; complementary endoscopic or surgical haemostatic therapy was employed for patients unresponsive to the initial management.


RESULTS
Despite prophylactic acid suppressive therapy, upper GI bleeding findings were consistently present in high risk patients, 69.4% presenting hematemesis and 55.6% presenting coffee-ground gastric content.


CONCLUSIONS
Each institution needs to have guidelines in place to establish the patients that actually have sufficient risk factors to justify stress gastritis prophylaxis.
Constantin
Vlad Denis
VD
St. Pantelimon Hospital, General Surgery Clinic, 340 Pantelimon Street, 73561 Bucharest, Romania. constantindenis@yahoo.com
Paun
Sorin
S
Ciofoaia
Victor V
VV
Budu
Vlad
V
Socea
Bogdan
B
D003131:Combined Modality Therapy; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000628:therapy*; D006635:Histamine H2 Antagonists / Q000627:therapeutic use; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D054328:Proton Pump Inhibitors / Q000627:therapeutic use; D012189:Retrospective Studies; D013276:Stomach Ulcer / Q000150:complications*; D013315:Stress, Psychological / Q000150:complications*
D006635:Histamine H2 Antagonists; D054328:Proton Pump Inhibitors