title: [Prophylaxis for stress ulcer bleeding in the intensive care unit].
abstract: BACKGROUND
  The critically ill patient can develop gastric erosions and, on occasion, stress ulcers with severe gastrointestinal bleeding that can be fatal.
  
  
  OBJECTIVE
  The purpose of this review was to provide current information on the pathophysiology, risk factors, and prophylaxis of digestive tract bleeding from stress ulcers in the intensive care unit.
  
  
  METHODS
  We identified articles through a PubMed search, covering the years 1970 to 2013. The most relevant articles were selected using the search phrases "stress ulcer", "stress ulcer bleeding prophylaxis", and "stress-related mucosal bleeding" in combination with "intensive care unit".
  
  
  RESULTS
  The incidence of clinically significant bleeding has decreased dramatically since 1980. The most important risk factors are respiratory failure and coagulopathy. Proton pump inhibitors (PPIs) or H2 receptor antagonists (H2RAs) are used in stress ulcer bleeding prophylaxis. Both drugs have been shown to be superior to placebo in reducing the risk for gastrointestinal bleeding and PPIs are at least as effective as H2RAs. Early enteral feeding has been shown to reduce the risk for stress ulcer bleeding, albeit in retrospective studies.
  
  
  CONCLUSIONS
  Admittance to the intensive care unit in itself does not justify prophylaxis. PPIs are at least as effective as H2RAs. We should individualize the treatment of each patient in the intensive care unit, determining risk and evaluating the need to begin prophylaxis.
authors.affiliation: Servicio de Endoscopia Digestiva, Hospital General de Mexicali ISESALUD, Mexicali B.C., México. Electronic address: jmar001@hotmail.com.
authors.forename: J M
authors.initials: JM
authors.lastname: Avendaño-Reyes
authors.affiliation: Servicio de Medicina Interna, Hospital General de Mexicali ISESALUD, Mexicali B. C., México.
authors.forename: H
authors.initials: H
authors.lastname: Jaramillo-Ramírez
mesh_terms: D000897:Anti-Ulcer Agents / Q000627:therapeutic use*; D003422:Critical Care; D006471:Gastrointestinal Hemorrhage / Q000209:etiology* / Q000517:prevention & control*; D006635:Histamine H2 Antagonists / Q000627:therapeutic use; D006801:Humans; D010439:Peptic Ulcer Perforation / Q000517:prevention & control; D054328:Proton Pump Inhibitors / Q000627:therapeutic use; D013276:Stomach Ulcer / Q000150:complications* / Q000188:drug therapy
chemical_list: D000897:Anti-Ulcer Agents; D006635:Histamine H2 Antagonists; D054328:Proton Pump Inhibitors
keywords: Antagonistas de los receptor H2; H2 receptor antagonists; Inhibidores de la bomba de protones; Intensive care unit; Mexico; Proton pump inhibitor; Sangrado por úlceras de estrés; Stress ulcer bleeding; Unidad cuidados intensivos