Stress ulcer prophylaxis — quo vadis?

The Case against Stress Ulcer Prophylaxis in 2007

“…This begs the question, of whether or not cases of SRMD are truly preventable by interventions that only target 1 part of the multifactorial insult that leads to SRMD. 17,18…”

Update: Assessment of Gastric pH in the Critically Ill

“…(45) What is the best way to measure gastric pH? (46) Can stress ulcer bleeding be prevented by aggressive treatment of hypoxemia with general measures to improve microcirculation and tissue oxygenation (Tryba, 1994) [31]? Despite the praiseworthy efforts of many investigators, these questions remain.…”

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morbidity (Jacobson, 1994) [20]. Some investigators believe that aggressive treatment of general tissue hypoxemia can prevent stress ulcer bleeding (Tryba, 1994)[31]. While intraluminal gastric pH (pH L ) is readily measured by aspirates tested with litmus paper or a nasogastric tube with an antimony or glass electrode tip that can monitor pH continuously, intramucosal gastric pH (pH I ) requires a more complicated assessment technique with a balloon tonometer.

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Use of Enteral Nutrition for Stress Ulcer Prophylaxis

“…11 Many clinicians question the need for initiating pharmacologic prophylaxis because it is difficult to identify those patients at highest risk for hemorrhage, and prophylaxis may not be cost effective. [12][13][14][15][16][17][18][19][20][21] The varying adverse effect profiles associated with different agents and the lack of consensus regarding the preferred agent further complicate the issue. Moreover, maintaining adequate mucosal perfusion has been shown to reduce the rate of clinically significant bleeding to 0.6% in the absence of stress ulcer prophylaxis.…”