title: Occult upper gastrointestinal mucosal abnormalities in critically ill patients.
abstract: BACKGROUND
  The objectives of this study were to estimate the frequency of occult upper gastrointestinal abnormalities, presence of gastric acid as a contributing factor, and associations with clinical outcomes.
  
  
  METHODS
  Data were extracted for study participants at a single centre who had an endoscopy performed purely for research purposes and in whom treating physicians were not suspecting gastrointestinal bleeding. Endoscopic data were independently adjudicated by two gastroenterologists who rated the likelihood that observed pathological abnormalities were related to gastric acid secretion using a 3-point ordinal scale (unlikely, possible or probable).
  
  
  RESULTS
  Endoscopy reports were extracted for 74 patients [age 52 (37, 65) years] undergoing endoscopy on day 5 [3, 9] of ICU admission. Abnormalities were found in 25 (34%) subjects: gastritis/erosions in 10 (14%), nasogastric tube trauma in 8 (11%), oesophagitis in 4 (5%) and non-bleeding duodenal ulceration in 3 (4%). The contribution of acid secretion to observed pathology was rated 'probable' in six subjects (rater #1) and five subjects (rater #2). Prior to endoscopy, 39 (53%) patients were receiving acid-suppressive therapy. The use of acid-suppressive therapy was not associated with the presence of an endoscopic abnormality (present 15/25 (60%) vs. absent 24/49 (49%); P = 0.46). Haemoglobin concentrations, packed red cells transfused and mortality were not associated with mucosal abnormalities (P = 0.83, P > 0.9 and P > 0.9 respectively).
  
  
  CONCLUSIONS
  Occult mucosal abnormalities were observed in one-third of subjects. The presence of mucosal abnormalities appeared to be independent of prior acid-suppressive therapy and was not associated with reduced haemoglobin concentrations, increased transfusion requirements, or mortality.
authors.affiliation: Discipline of Acute Care Medicine, University of Adelaide, Adelaide, SA, Australia.
authors.forename: C
authors.initials: C
authors.lastname: Ovenden
authors.affiliation: Discipline of Acute Care Medicine, University of Adelaide, Adelaide, SA, Australia.|Neurosciences Critical Care Unit, Addenbrooke's Hospital, Cambridge, UK.
authors.forename: M P
authors.initials: MP
authors.lastname: Plummer
authors.affiliation: Discipline of Acute Care Medicine, University of Adelaide, Adelaide, SA, Australia.
authors.forename: S
authors.initials: S
authors.lastname: Selvanderan
authors.affiliation: Department of Anaesthesia, Royal Adelaide Hospital, Adelaide, SA, Australia.
authors.forename: T A
authors.initials: TA
authors.lastname: Donaldson
authors.affiliation: Centre for Research Excellence in Translating Nutritional Science to Good Health, Adelaide, SA, Australia.|Discipline of Medicine, University of Adelaide, Adelaide, SA, Australia.|Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide, SA, Australia.
authors.forename: N Q
authors.initials: NQ
authors.lastname: Nguyen
authors.affiliation: Department of Critical Care Services, Royal Adelaide Hospital, Adelaide, SA, Australia.
authors.forename: L M
authors.initials: LM
authors.lastname: Weinel
authors.affiliation: Discipline of Acute Care Medicine, University of Adelaide, Adelaide, SA, Australia.|Department of Critical Care Services, Royal Adelaide Hospital, Adelaide, SA, Australia.
authors.forename: M E
authors.initials: ME
authors.lastname: Finnis
authors.affiliation: Department of Critical Care Services, Royal Adelaide Hospital, Adelaide, SA, Australia.
authors.forename: M J
authors.initials: MJ
authors.lastname: Summers
authors.affiliation: Discipline of Acute Care Medicine, University of Adelaide, Adelaide, SA, Australia.
authors.forename: Y
authors.initials: Y
authors.lastname: Ali Abdelhamid
authors.affiliation: Discipline of Acute Care Medicine, University of Adelaide, Adelaide, SA, Australia.|Centre for Research Excellence in Translating Nutritional Science to Good Health, Adelaide, SA, Australia.|Department of Critical Care Services, Royal Adelaide Hospital, Adelaide, SA, Australia.
authors.forename: M J
authors.initials: MJ
authors.lastname: Chapman
authors.affiliation: Centre for Research Excellence in Translating Nutritional Science to Good Health, Adelaide, SA, Australia.|Discipline of Medicine, University of Adelaide, Adelaide, SA, Australia.|Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide, SA, Australia.
authors.forename: C K
authors.initials: CK
authors.lastname: Rayner
authors.affiliation: Discipline of Acute Care Medicine, University of Adelaide, Adelaide, SA, Australia.|Department of Critical Care Services, Royal Adelaide Hospital, Adelaide, SA, Australia.|Intensive Care Unit, The Royal Melbourne Hospital, Parkville, Vic., Australia.
authors.forename: A M
authors.initials: AM
authors.lastname: Deane
mesh_terms: D000328:Adult; D000368:Aged; D016638:Critical Illness; D016099:Endoscopy, Gastrointestinal; D004941:Esophagitis / Q000473:pathology*; D005260:Female; D005756:Gastritis / Q000473:pathology*; D006801:Humans; D007362:Intensive Care Units; D007413:Intestinal Mucosa / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D054328:Proton Pump Inhibitors / Q000627:therapeutic use
chemical_list: D054328:Proton Pump Inhibitors