title: Prevention of stress-related ulcer bleeding at the intensive care unit: Risks and benefits of stress ulcer prophylaxis.
abstract: Stress-related mucosal disease is a typical complication of critically ill patients in the intensive care unit (ICU). It poses a risk of clinically relevant upper gastrointestinal (GI) bleeding. Therefore, stress ulcer prophylaxis (SUP) is recommended in high-risk patients, especially those mechanically ventilated > 48 h and those with a manifest coagulopathy. Proton pump inhibitors (PPI) and, less effectively, histamine 2 receptor antagonists (H2RA) prevent GI bleeding in critically ill patients in the ICU. However, the routine use of pharmacological SUP does not reduce overall mortality in ICU patients. Moreover, recent studies revealed that SUP in the ICU might be associated with potential harm such as an increased risk of infectious complications, especially nosocomial pneumonia and Clostridium difficile-associated diarrhea. Additionally, special populations such as patients with liver cirrhosis may even have an increased mortality rate if treated with PPI. Likewise, PPI can be toxic for both the liver and the bone marrow, and some PPI show clinically relevant interactions with important other drugs like clopidogrel. Therefore, the agent of choice, the specific balance of risks and benefits for individual patients as well as the possible dose of PPI has to be chosen carefully. Alternatives to PPI prophylaxis include H2RA and/or sucralfate. Instead of routine SUP, further trials should investigate risk-adjusted algorithms, balancing benefits and threats of SUP medication in the ICU.
authors: Lukas Buendgens, Alexander Koch, Frank Tacke, Department of Medicine III, University Hospital Aachen, 52074 Aachen, Germany.
authors: Lukas
authors: L
authors: Buendgens
authors: Lukas Buendgens, Alexander Koch, Frank Tacke, Department of Medicine III, University Hospital Aachen, 52074 Aachen, Germany.
authors: Alexander
authors: A
authors: Koch
authors: Lukas Buendgens, Alexander Koch, Frank Tacke, Department of Medicine III, University Hospital Aachen, 52074 Aachen, Germany.
authors: Frank
authors: F
authors: Tacke
keywords: Clostridium difficile; Gastrointestinal hemorrhage; Histamine H2 antagonists; Intensive care unit; Physiological; Pneumonia; Proton pump inhibitors; Risk assessment; Stress; Sucralfate