A Prospective Study of Stress Ulceration in Vietnam

Jc, Bowen; Wh, Fleming

doi:10.1097/00007611-197402000-00008

Cited by 16 publications

(5 citation statements)

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“…Furthermore, while many studies involving more heterogeneous patient populations included trauma patients, there were often insufficient numbers of these patients to draw any definitive conclusions. The relative lack of prospective studies involving trauma patients is somewhat surprising given the relationship between injury and gastrointestinal ulceration that was well described during the Korean and Vietnam wars [3,4]. …”

Section: Introductionmentioning

confidence: 99%

Stress ulcer prophylaxis in trauma patients

2002

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IntroductionThere are numerous randomized, controlled trials and several meta-analyses evaluating drug therapy for stress ulcer prophylaxis [1]. While these publications have shown significant benefit with using prophylaxis, a number of issues still remain unresolved. For example, Cook et al. performed a meta-analysis of published and unpublished research, and they concluded that sucralfate might be as effective as pH-altering medication in preventing stress-induced bleeding, with a lower incidence of pneumonia and mortality [1]. In a subsequent multicenter, randomized trial involving 1200 patients, Cook et al. found a lower incidence of clinically important gastrointestinal bleeding with ranitidine compared with sucralfate (relative risk, 0.44; 95% confidence interval, 0.21-0.92; P = 0.02), with no differences in pneumonia or mortality [2].In contrast to the multiple, and often conflicting, studies of stress ulcer prophylaxis conducted in general medical and surgical populations, decisions concerning appropriate stress H2 = histamine-2; ICU = intensive care unit. AbstractIntroduction A number of issues concerning stress ulcer prophylaxis remain unresolved despite numerous randomized, controlled trials and several meta-analyses. The role of stress ulcer prophylaxis, particularly in trauma patients, is further complicated by the lack of trials utilizing clinically important bleeding as an endpoint. Given the lack of consensus regarding stress ulcer prophylaxis in trauma patients, prescribing practices at Level I trauma centers in the United States were assessed. Materials and methods A survey was developed that contained questions related to institutional prescribing and evaluation of stress ulcer prophylaxis. The survey was intended to delineate these practices at the 188 Level I trauma centers (at the time of the present survey) in the United States. Results One hundred and nineteen surveys were returned, yielding a response rate of 63%. Eighty-six percent stated that medications for stress ulcer prophylaxis are used in a vast majority of trauma patients admitted to the intensive care unit. Sixty-five percent stated that there is one preferred medication. For these institutions, histamine-2-blockers were the most popular at 71%. Thirty-nine percent stated that greater than 50% of patients remain on stress ulcer prophylaxis following discharge from the intensive care unit. Conclusion The lack of consensus with regards to appropriate stress ulcer prophylaxis is apparent in this survey of Level I trauma centers. For those institutions with a preferred agent, histamine-2-blockers were most common.

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Section: Introductionmentioning

confidence: 99%

Stress ulcer prophylaxis in trauma patients

2002

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“…Thus, the reported occurrence of bleeding in these patients can vary according to the diagnostic criteria. In a study of trauma patients, the majority had endoscopic evidence of gastric mucosal lesions [33]. Fifty-one percent had evidence of occult blood in the nasogastric aspirate, and 24% required transfusions [33].…”

Section: Clinical Presentation and Coursementioning

confidence: 99%

“…In a study of trauma patients, the majority had endoscopic evidence of gastric mucosal lesions [33]. Fifty-one percent had evidence of occult blood in the nasogastric aspirate, and 24% required transfusions [33]. A prospective study of medical ICU patients found a 14% overall prevalence of occult plus overt bleeding, but only 6% of patients had clinically significant bleeding [18].…”

Section: Clinical Presentation and Coursementioning

confidence: 99%

Stress Ulcer Syndrome

Zuckerman

Cort

Shuman

1988

J Intensive Care Med

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MO 63110.Stress ulcer syndrome refers to gastroduodenal erosions or ulcers that develop acutely in relation to major physiological stress, usually manifested clinically as upper gastrointestinal (UGI) bleeding. These lesions occur most often in the gastric fundus. Endoscopy has shown gastroduodenal mucosal lesions in 75 to 100% of intensive care unit (ICU) patients within 72 hours of admission. Patients at high risk for stress ulcer include those with large body surface area burns, intracranial lesions associated with coma, fulminant hepatic failure, sepsis, and trauma and abdominal, cardiovascular, and thoracic surgery patients. Also considered high risk are ICU patients with superimposed complications such as shock, mechanical ventilation for more than 3 days, coagulopathy, jaundice, and sepsis. Approximately 15% of ICU patients will experience UGI bleeding from stress ulcer. Patients bleeding from stress ulcer have an overall mortality rate approaching 65% compared with 9 to 22% mortality in patients without stress ulcer. When stratified according to occult blood loss versus clinically significant bleeding, mortality can be as high as 90% in patients overtly bleeding; 30% of deaths are directly related to bleeding. Both antacids and H 2 receptor antagonists are effective in prophylaxis for stress ulcer bleeding.Gastrointestinal bleeding is a major problem in intensive care medicine, and upper gastrointestinal (UGI) hemorrhage may occur in 10% or more of intensive care unit (ICU) patients [1]. Bleeding representing the usual spectrum of UGI mucosal lesions can be responsible for admission to the ICU, but bleeding can also be a secondary complication that occurs during the ICU stay. The latter has been referred to as the clinical syndrome of &dquo;stress ulcer.&dquo; Stress ulcers are acutely formed defects in the gastroduodenal mucosa that develop in a critically ill patient with a severe physiological derangement.

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“…Je nach Krankheitsbild liegt die Hfiufigkeit dieser oft lebensbedrohenden Komplikation zwischen 11 und 50% [1,2,6]. Je nach Krankheitsbild liegt die Hfiufigkeit dieser oft lebensbedrohenden Komplikation zwischen 11 und 50% [1,2,6].…”

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Ranitidin und Cimetidin in der Prophylaxe der Stre�ulcus-Blutung: Eine prospektive Multicenter-Vergleichsstudie

Ho¹,

Berg

Brunner

et al. 1984

Langenbecks Arch Chiv

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In a multicentre single-blind study, ranitidine was compared to cimetidine as prophylactic treatment against stress-induced upper gastrointestinal bleeding in seriously ill patients in the intensive care unit (ICU). 380 patients entered the study. 192 patients were treated with ranitidine 50 mg q.i.d. as i.v. bolus followed by 150 mg orally twice daily. 188 patients received cimetidine 400 mg q.i.d. intravenously and 1,000 mg daily orally in divided doses. Five patients in the ranitidine group (2.6%) and 12 in the cimetidine group (6.4%) developed gastrointestinal bleeding definitely or possibly due to stress lesions. This difference was not significant. The incidence of stress erosions or ulcerations developing during the study was 11.8% for the ranitidine group and 18.3% for the cimetidine group (non-significant difference). Adverse events in the ranitidine group were nausea, tachycardia or vomiting in 4 patients. 5 cimetidine-treated patients developed cholestasis, and 5 additional central nervous system problems. The high degree of efficacy of both drugs compared very favourably with the high incidence of stress ulceration and hemorrhage in similar untreated populations.

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A Prospective Study of Stress Ulceration in Vietnam

Cited by 16 publications

References 0 publications

Stress ulcer prophylaxis in trauma patients

Stress ulcer prophylaxis in trauma patients

Stress Ulcer Syndrome

Ranitidin und Cimetidin in der Prophylaxe der Stre�ulcus-Blutung: Eine prospektive Multicenter-Vergleichsstudie

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