gastrointestinal disorders
Erosive Gastritis
Prevention of Erosive Gastritis
Prophylaxis with acid-suppressive medications can reduce the incidence of acute stress gastritis. However, it mainly benefits certain high-risk intensive care unit patients, including those with severe burns, central nervous system trauma, coagulopathy, sepsis, shock, multiple trauma, mechanical ventilation for > 48 hours, chronic liver disease, acute kidney injury, hepatic or renal failure, multiorgan dysfunction, and history of peptic ulcer or gastrointestinal bleeding. recommends that in most critically ill patients the benefit of acid suppression must be weighed against the risk of pneumonia. The guideline includes a calculator to help assess the risk of gastrointestinal bleeding. There is a possible increased risk of nosocomial pneumonia in critically ill patients receiving acid suppression. A recent meta-analysis concluded that proton pump inhibitors (PPIs) and histamine-2 receptor antagonists may increase the risk of pneumonia (absolute increases 5% for PPIs and 3.4% for histamine-2 receptor antagonists; Treatment references ). However, a previous large clinical study of a PPI for patients at risk of gastrointestinal bleeding in the intensive care unit found no increased incidence of pneumonia ( Early enteral feeding also can decrease the incidence of bleeding. Acid suppression is not recommended for patients simply taking nonsteroidal anti-inflammatory drugs unless they have previously had an ulcer. 1.Wang Y, Ye Z, Ge L, et al: Efficacy and safety of gastrointestinal bleeding prophylaxis in critically ill patients: Systematic review and network meta-analysis.BMJ368:l6744, 2020. doi: 10.1136/bmj.l6744PMCID 2.Krag M, Marker S, Perner A, et al:Pantoprazolein patients at risk for gastrointestinal bleeding in the ICU.N Engl J Med379(23):2199–2208, 2018. doi: 10.1056/NEJMoa1714919 