A variety of medical factors can create stress and place a patient at at risk of gastroduodenal ulcerations and bleeding. Among teh most common are prolonged mechanical ventilation, coagulopathy, multiple injuries, spinal cord injury, injury, acute renal failure, and administration of high-dose steroids. The latter usually ocurrs in the setting of chemotherapy.
A variety of interventions have been studied, including: Histamine-2 receptor antagonists, Proton pump inhibitors , Cytoprotective agents. All of these options are supported by published clinical studies. Several have been found to be ineffective or harmful: Use of antacids has been associated with a potential increase in the risk of hemorrhage. Enteral feeding also has failed to show significant increases in gastric PH but some proponents remain.
Guillamondegui OD, Gunter OL Jr, Bonadies JA, Coates JE, Kurek SJ, De Moya MA, Sing RF, Sori AJ. Practice management guidelines for stress ulcer prophylaxis. Chicago (IL): Eastern Association for the Surgery of Trauma (EAST); 2008. 24 p. [58 references]
ASHP therapeutic guidelines on stress ulcer prophylaxis. ASHP Commission on Therapeutics and approved by the ASHP Board of Directors on November 14, 1998. Am J Health Syst Pharm. 1999;56:347-379.(note will be updated in 2012)
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