Esophageal and Gastric Bleeding
John F. Pohl, Christopher Jolley, Daniel Gelfond in Pediatric Gastroenterology, 2014
NSAIDs are some of the most commonly used medications in children. Through their effect on prostaglandin metabolism, NSAIDs impair the gastric mucosal healing and are associated with ulcerations that are commonly asymptomatic. In a subset of patients, significant ulceration and bleeding may occur (52.3). NSAID ulcers tend to be superficial and diffuse. The presence of H. pylori is associated with higher bleeding risk. Moreover, critically ill patients who have a higher risk of gastric bleeding (so called ‘stress ulcer’) may also be more sensitive to NSAID effects and subsequent bleeding. Although some data suggest that critically ill children may benefit from prophylaxis against UGI bleeding, there remains no high quality evidence to guide clinical practice. Selective cyclo-oxygenase-2 inhibitors may carry a lower risk for bleeding. Patients who are unable to discontinue NSAIDs may decrease the bleeding risk by taking acid-reducing medications concomitantly.
Effects of Dopamine on The Digestive System
M.D. Francesco Amenta in Peripheral Dopamine Pathophysiology, 2019
The exact mechanism of the ulcerogenic effect of cysteamine and propionitrile and of the antiulcerogenic effect of DA receptor agonists remains unclear. Although it seems probable that DA receptors are involved, the site and type of these receptors is unclear. In a study of a large series of DA receptor agonists in the cysteamine model, only apomorphine, bromocriptine, lergotrile, and L-dopa were antiulcerogenic, while pergolide, dipropyldo-pamine, LY-171555, epinine, SK&F 38393A, N-2-chloroethyl-norapomorphine, and 6,7-ADTN were not.188 This does not fit in with the known activity of these agonists in other assays of dopaminergic function. It should finally be remembered that the involvement of DA as an inhibitory factor in the pathogenesis of duodenal ulcer is based on results obtained in rats. A retrospective study of autopsy reports in intensive care patients did not show a decrease in stress ulcer formation upon introduction of DA treatment in intensive care units.195 In contrast, a preliminary report of a recent open study mentioned a healing effect of bromocriptine in peptic ulcer patients.196
Systemic care—Renal, hematologic, gastrointestinal
Hemanshu Prabhakar, Charu Mahajan, Indu Kapoor in Essentials of Anesthesia for Neurotrauma, 2018
Critically ill patients are at risk of stress-related gastrointestinal ulcers and subsequent GI hemorrhage, which are associated with a prolonged ICU stay and increased mortality. Only 1% to 6% of patients with a GI ulcer who are admitted to the ICU develop bleeding.61 The pathophysiology of a GI stress ulcer is multifactorial and it is not fully understood. A loss of the balance between protective and destructive factors is thought to play an important role. A gastric ulcer related to brain injury is referred to as a Cushing ulcer which is initially identified with and attributable to elevated intracranial pressure. Risk factors for stress-ulcer GI bleeding include respiratory failure requiring mechanical ventilation for >48 h, coagulopathy (platelet count <50,000, INR >1.5, or PTT more than two times the control value), hepatic injury, acute kidney injury, maximum creatinine level, acute respiratory failure, sepsis, hypotension, severe head or spinal cord injury, anticoagulation, history of gastrointestinal bleeding, low intragastric pH, thermal injury involving more than 35% of the body surface area, major surgery longer than 4 hours, high dose steroid (>250 mg/day) use, age >50 years, and male sex.61–64 In TBI patients, factors predisposing a patient to stress ulcer (ie, acid, pepsin, and cortisol) have been found to increase63,64 and the incidence of GI bleeding in these patients strongly correlates with the severity of a head injury.65
Proton pump inhibitors: use and misuse in the clinical setting
Published in Expert Review of Clinical Pharmacology, 2018
Vincenzo Savarino, Elisa Marabotto, Patrizia Zentilin, Manuele Furnari, Giorgia Bodini, Costanza De Maria, Gaia Pellegatta, Claudia Coppo, Edoardo Savarino
Stress ulcer is an acute condition occurring in patients admitted in ICUs and is commonly located in the proximal stomach. It seems to be the result of an ischemic damage reducing the mucosal defense, thereby acid acts only as a secondary factor. Current guidelines approve the use of PPIs as stress ulcer prophylaxis (SUP) in ICU patients at high risk of GI bleeding, such as those who require mechanical ventilation for more than 48 h or those with coagulopathy, who have an OR of 15.6 and 4.3, respectively [73]. Several large meta-analyses found that the risk of bleeding in ICUs is reduced by about 60% in patients receiving SUP compared with those treated with placebo or no prophylaxis [74,75]. Therefore, SUP has become the standard of care in the ICUs, sometimes irrespective of the presence of risk factors.
Stress-related upper gastrointestinal bleeding in adult neurocritical care patients: a Chinese multicenter, retrospective study
Published in Current Medical Research and Opinion, 2019
Junji Wei, Rongcai Jiang, Lihong Li, Dezhi Kang, Guodong Gao, Chao You, Jianmin Zhang, Liang Gao, Qibing Huang, Duanwu Luo, Gang Zhao, Hongyi Zhang, Shuo Wang, Renzhi Wang
Higher incidence of UGIB in critically ill neurosurgical patients was associated with risk factors such as GI ulcer or UGIB history, previous treatment with anticoagulants (blood thinners that delay blood clotting) or anti-platelets (drugs that keep blood clots from forming by preventing blood platelets from sticking together) (Tables 2 and 3), and mechanical ventilation for >48 hours. Although the incidence of stress GI bleeding in our study was not very high, the rates were higher than the estimated incidence; moreover, stress ulcers cannot be neglected because >50% of the patients develop mucosal damage within 24 hours of hospitalization, and have severe associated complications and high mortality rates3,5–8. This indicates stress ulcer becoming an alarming condition if untreated. Interestingly, the mnemonic FAST HUG (Feeding, Analgesia, Sedation, Thromboembolic prophylaxis, Head-of-bed elevation, stress Ulcer prevention, and Glucose control) described by Vincent et al. suggests that clinicians use SUP on a daily basis for improving the quality of care received by critically ill patients30.
Enteral combined with parenteral nutrition improves clinical outcomes in patients with traumatic brain injury
Published in Nutritional Neuroscience, 2022
Xiaomin Li, Yafeng Yang, Zheng Feei Ma, Shan Gao, Yuan Ning, Ling Zhao, Zhangya He, Xiaoqin Luo
Gastrointestinal intolerance was mainly monitored from three aspects: bloating and abdominal pain, nausea and vomiting, and diarrhea. Diarrhea is referred as an increase in the number of defecations (> 3 times/day), an increase in the amount of stool (> 200g/d), and a thin stool (water content>85%) [7]. According to the recommendations of the editorial board of the Chinese Medical Journal, one of the following cases can be identified as a stress ulcer: a positive stool blood test or occult blood test; a gastrointestinal decompression in red or black or brown, and a positive occult blood test [8]. The diagnostic criteria for intracranial infection and pulmonary infection are referred to the ‘Diagnostic Standards for Nosocomial Infections’ of the Ministry of Health.
Related Knowledge Centers
- Gastrointestinal Tract
- Mucous Membrane
- Pylorus
- Stress
- Upper Gastrointestinal Bleeding
- Stomach
- Duodenum
- Helicobacter Pylori
- Peptic Ulcer Disease
- Gastric Glands