title: Stress-related mucosal disease: incidence of bleeding and the role of omeprazole in its prophylaxis.
abstract: BACKGROUND
  Upper gastrointestinal bleeding is the severe complication of stress-related mucosal disease in hospitalized patients. In intensive care units (ICU), risk factors are well defined and only mechanical ventilation and coagulopathy proved to be relevant for significant bleeding. On the contrary, in non-ICU settings there is no consensus about this issue. Nevertheless, omeprazole is still widely used in prophylaxis of bleeding. The objective of our study was to evaluate the relevance of stress-related mucosal disease bleeding in patients admitted to an internal medicine ward, and the role of omeprazole in its prophylaxis.
  
  
  METHODS
  We conducted a retrospective study in which we analysed consecutive patients who were admitted to our ward over a year. We recorded demographic characteristics of the patients, potential risk factors for stress-related mucosal disease (clinical data, laboratory, and medication), administration of prophylactic omeprazole, and total cost of this prophylaxis. Patients with active gastrointestinal bleeding on the admission were excluded. We recorded every upper gastrointestinal bleeding event with clinical relevance.
  
  
  RESULTS
  Five hundred and thirty-five patients, mean age 70 years, mean length of stay 9.6+/-7.7 days; 140 (26.2%) patients were treated with 40 mg of omeprazole intravenously, 193 (36.1%) with 20mg of omeprazole orally, and 202 (37.8%) patients had no prophylaxis. There was only one episode (0.2%) of clinically relevant bleeding.
  
  
  CONCLUSIONS
  In patients admitted to an internal medicine ward, incidence of upper gastrointestinal bleeding as a complication of stress-related mucosal disease is low. We found that there is no advantage in prophylaxis with omeprazole.
authors.affiliation: Department of Medicine II, Curry Cabral Hospital, and Pharmacology Department, Faculty of Medical Sciences, New University of Lisbon, Campo Mártires da Pátria 130, Lisbon, Portugal. marta.amaral@fcm.unl.pt
authors.forename: Marta C
authors.initials: MC
authors.lastname: Amaral
authors.forename: Catarina
authors.initials: C
authors.lastname: Favas
authors.forename: J Delgado
authors.initials: JD
authors.lastname: Alves
authors.forename: Nuno
authors.initials: N
authors.lastname: Riso
authors.forename: M Vaz
authors.initials: MV
authors.lastname: Riscado
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000897:Anti-Ulcer Agents / Q000008:administration & dosage*; D005260:Female; D005753:Gastric Mucosa / Q000187:drug effects; D006471:Gastrointestinal Hemorrhage / Q000453:epidemiology* / Q000517:prevention & control*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009853:Omeprazole / Q000008:administration & dosage*; D012307:Risk Factors; D013315:Stress, Psychological / Q000453:epidemiology*; D041742:Upper Gastrointestinal Tract / Q000187:drug effects; D055815:Young Adult
chemical_list: D000897:Anti-Ulcer Agents; D009853:Omeprazole