Stress ulcer prevention

Stress Ulcer Prevention is a critical aspect of medical care, particularly in patients who are critically ill or in those undergoing major surgeries. Stress ulcers are a type of peptic ulcer that occur due to the physical stress of serious illness. Unlike ulcers caused by medications or Helicobacter pylori infection, stress ulcers typically arise in the stomach or duodenum due to a compromised blood supply and the body's inability to protect the gastrointestinal lining from acid. This article outlines the key strategies and considerations in preventing stress ulcers.

Etiology

Stress ulcers can develop in response to severe physical stress, such as trauma, surgery, burns, or critical illness. The pathophysiology involves a reduction in mucosal blood flow, leading to ischemia, and an imbalance between aggressive factors like gastric acid and defensive mechanisms of the gastrointestinal mucosa.

Risk Factors

Identifying patients at high risk for developing stress ulcers is a crucial step in prevention. Key risk factors include mechanical ventilation for more than 48 hours, coagulopathy, sepsis, traumatic brain injury, and extensive burns. Patients with these conditions should be assessed promptly for stress ulcer prophylaxis.

Prevention Strategies

Prevention of stress ulcers involves both pharmacological and non-pharmacological approaches.

Pharmacological Prophylaxis

The mainstay of pharmacological prophylaxis includes the use of Proton Pump Inhibitors (PPIs) and Histamine-2 Receptor Antagonists (H2RAs). PPIs are often preferred due to their superior acid suppression. However, the choice between PPIs and H2RAs should be individualized based on the patient's risk factors and potential side effects.

Non-Pharmacological Measures

Non-pharmacological measures include maintaining a healthy lifestyle, avoiding non-steroidal anti-inflammatory drugs (NSAIDs), and reducing stress. In critically ill patients, enteral nutrition is also recommended to help maintain the integrity of the gastrointestinal mucosa.

Monitoring and Management

Patients receiving stress ulcer prophylaxis should be monitored for potential side effects of medications, such as increased risk of pneumonia, Clostridium difficile infection, and interference with the absorption of other drugs. The need for ongoing prophylaxis should be regularly reviewed and discontinued when the risk of stress ulceration is deemed to have subsided.

Conclusion

Preventing stress ulcers in high-risk patients is an essential component of care in the critical care setting. Through the judicious use of pharmacological agents and the implementation of non-pharmacological measures, the incidence of stress ulcers and their complications can be significantly reduced.