title: Stress-related mucosal disease in the critically ill patient.
abstract: Bleeding from stress-related mucosal disease in critically ill patients remains an important clinical management issue. Although only a small proportion (1-6%) of patients admitted to an intensive care unit (ICU) will bleed, a substantial proportion exhibit clinical risk factors (mechanical ventilation for >48 h and a coagulopathy) that predict an increased risk of bleeding. Furthermore, upper gastrointestinal mucosal lesions can be found in 75-100% of patients in ICUs. Although uncommon, stress-ulcer bleeding is a severe complication with an estimated mortality of 40-50%, mostly from decompensating an underlying condition or multiorgan failure. Although the vast majority of patients in ICUs receive stress-ulcer prophylaxis, largely with PPIs, some controversy surrounds their efficacy and safety. Indeed, no single trial has shown that stress-ulcer prophylaxis reduces mortality. Some reports suggest that the use of PPIs increases the risk of nosocomial infections. However, several meta-analyses and cost-effectiveness studies suggest PPIs to be more clinically effective and cost-effective than histamine-2 receptor antagonists, without considerable increases in nosocomial pneumonia. To help clinicians use the most appropriate strategy for treatment of patients in the ICU, this Review presents the latest information on all aspects of stress-related mucosal disease.
authors.affiliation: Gastroenterology and Hepatology Department, CHU de Dijon, France, 14 Rue Gaffarel BP77908, 21079 Dijon Cedex, France.
authors.forename: Marc
authors.initials: M
authors.lastname: Bardou
authors.affiliation: Medical Intensive Care Unit, CHU de Dijon, France, 14 Rue Gaffarel BP77908, 21079 Dijon Cedex, France.
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Quenot
authors.affiliation: Gastroenterology Department, McGill University Health Centre, Montreal General Hospital Site, Room D7-346, 1650 Cedar Avenue, Montréal, QC H3G 1A4, Canada.
authors.forename: Alan
authors.initials: A
authors.lastname: Barkun
mesh_terms: D016638:Critical Illness / Q000628:therapy*; D004750:Enteral Nutrition / Q000379:methods; D006801:Humans; D010438:Peptic Ulcer Hemorrhage / Q000209:etiology* / Q000517:prevention & control; D054328:Proton Pump Inhibitors / Q000009:adverse effects / Q000627:therapeutic use; D012307:Risk Factors; D013276:Stomach Ulcer / Q000150:complications / Q000517:prevention & control; D013312:Stress, Physiological
chemical_list: D054328:Proton Pump Inhibitors