142:, and/or need for transfusion, were seen in 1.5% of patients in the 2252 patients in the Canadian Critical Care Trials group study. People with stress ulcers have a longer ICU length of stay (up to eight days) and a higher mortality (up to four-fold) than patients who do not have stress ulceration and bleeding. While the bleeding and transfusions associated with the stress ulcerations contribute to the increased mortality, the contribution of factors like
334:
In case of severe hemorrhagic or erosive gastritis and stress ulcers, a combination of antacids and H2-blockers may stop active bleeding and prevent bleeding from happening again. In selected patients, either endoscopic therapy or selective infusion of vasopressin into the left gastric artery may
330:
Treatment of stress ulceration usually begins with prevention. Careful attention to respiratory status, acid-base balance, and treatment of other illnesses help prevent the conditions under which stress ulcers occur. Patients who develop stress ulcers typically do not secrete large quantities of
284:
The need for medications to prevent stress ulcer among those in the intensive care unit is unclear. As of 2014, the quality of the evidence is poor. It is unclear which agent is best or if prevention is needed at all. Benefit may only occur in those who are not being fed. Possible agents include
272:
Stress ulcer is suspected when there is upper gastrointestinal bleeding in the appropriate clinical setting, for example, when there is upper gastrointestinal bleeding in elderly patients in a surgical intensive care unit (ICU) with heart and lung disease, or when there is upper gastrointestinal
235:
The ulcerations may be superficial and confined to the mucosa, in which case they are more appropriately called erosions, or they may penetrate deeper into the submucosa. The former may cause diffuse mucosal oozing of blood, whereas the latter may erode into a submucosal vessel and produce frank
534:
Krag, M; Perner, A; Wetterslev, J; Wise, MP; Hylander Møller, M (Jan 2014). "Stress ulcer prophylaxis versus placebo or no prophylaxis in critically ill patients. A systematic review of randomised clinical trials with meta-analysis and trial sequential analysis".
251:
Generally, there are multiple lesions located mainly in the stomach and occasionally in the duodenum. They range in depth from mere shedding of the superficial epithelium (erosion) to deeper lesions that involve the entire mucosal thickness (ulceration).
263:
The pathogenesis of stress ulcer is unclear but probably is related to a reduction in mucosal blood flow or a breakdown in other normal mucosal defense mechanisms in conjunction with the injurious effects of acid and pepsin on the gastroduodenal mucosa.
669:
Alhazzani, W; Alenezi, F; Jaeschke, RZ; Moayyedi, P; Cook, DJ (Mar 2013). "Proton pump inhibitors versus histamine 2 receptor antagonists for stress ulcer prophylaxis in critically ill patients: a systematic review and meta-analysis".
162:
Risk factors for stress ulcer formation that have been identified are numerous and varied. However, two landmark studies and one position paper exist that addresses the topic of risk factors for stress ulcer formation:
326:
Endoscopic means of treating stress ulceration may be ineffective and operation required. It is believed that shunting blood away from the mucosa makes the mucous membrane ischaemic and more susceptible to injury.
331:
gastric acid; however, acid does appear to be involved in the pathogenesis of the lesions. Thus it is reasonable either to neutralize acid or to inhibit its secretion in patients at high risk.
1378:
1009:
769:
76:, trauma or other conditions and are found in patients with chronic illnesses. These ulcers are a significant issue in patients in critical and intensive care.
578:
Krag, M; Perner, A; Wetterslev, J; Møller, MH (Aug 2013). "Stress ulcer prophylaxis in the intensive care unit: is it indicated? A topical systematic review".
1047:
221:
The
American Society of Health-System Pharmacists guideline recommends against the practice of stress ulcer prophylaxis in non-critically ill patients.
1457:
626:
Marik, PE; Vasu, T; Hirani, A; Pachinburavan, M (Nov 2010). "Stress ulcer prophylaxis in the new millennium: a systematic review and meta-analysis".
875:
414:"The attributable mortality and length of intensive care unit stay of clinically important gastrointestinal bleeding in critically ill patients"
276:
Stress ulcer can be diagnosed after the initial management of gastrointestinal bleeding, the diagnosis can be confirmed by upper GI endoscopy.
762:
970:
955:
895:
93:
is a proper medical term and should not be misinterpreted as indicating that these ulcers are caused by emotional stress. Here the term
89:
and its role in the formation of this ulcer. Stress ulcers are a different condition and are formed by different mechanisms. The term
1368:
1065:
720:
1452:
755:
323:
The principles of management are the same as for the chronic ulcer. The steps of management are similar as in erosive gastritis.
1211:
1070:
1003:
309:
65:
1342:
509:
485:
741:
A Practical
Approach to Emergency Medicine by Robert J. Stine, M.D., Carl R. Chudnofsky, M.D., Cynthia K. Aaron, M.D. (1994)
849:
832:
826:
1252:
1186:
83:(a different type of ulcer) could be caused by psychological stress but this was proven false with the discovery of
844:
789:
1373:
1169:
1164:
1115:
43:
1267:
1110:
1095:
778:
35:
1347:
130:. Stress ulcers tend to present with multiple lesions whereas in peptic ulcers this is much more uncommon.
1149:
732:
Manual of
Gastroenterology priyank sinha Gregory L. Eastwood, M.D. & Canan Avunduk, M.D., Ph.D. (1994)
298:
172:
103:
1352:
1273:
211:
245:
1204:
1024:
167:
Non-critically ill medical patients with two or more of the following: respiratory failure, sepsis,
1247:
1154:
965:
960:
950:
903:
820:
804:
290:
151:
85:
69:
1296:
1127:
1060:
977:
938:
913:
838:
695:
651:
603:
560:
394:
462:
Manual of
Gastroenterology by Gregory L. Eastwood, M.D. & Canan Avunduk, M.D., Ph.D. (1994)
1399:
1145:
945:
923:
908:
799:
716:
687:
643:
595:
552:
505:
481:
445:
386:
30:
1257:
928:
679:
635:
587:
544:
435:
425:
376:
244:
The characteristic lesions may be multiple, superficial mucosal erosions similar to erosive
94:
61:
39:
1283:
1181:
1055:
192:
1394:
1237:
1014:
343:
Among those in the intensive care unit, ulceration resulting in bleeding is very rare.
180:
111:
1446:
1122:
1105:
440:
413:
168:
119:
80:
655:
607:
564:
398:
304:
Concerns with the use of stress ulcer prophylaxis agents include increased rates of
248:. Occasionally, there may be a large acute ulcer in the duodenum (Curling's ulcer).
102:
Another distinction between peptic and stress ulcers is their location in the upper
1431:
1332:
1199:
1191:
1137:
1075:
1039:
933:
890:
699:
215:
188:
138:
Stress ulcers, as defined by overt bleeding and hemodynamic instability, decreased
107:
683:
639:
1414:
1337:
918:
381:
364:
143:
1421:
1404:
1316:
1232:
1176:
982:
548:
301:(PPIs). Tentative evidence supports that PPIs may be better than H2 blockers.
294:
139:
1409:
1291:
1227:
305:
691:
647:
599:
556:
449:
154:
to the mortality independently of the stress ulceration cannot be ignored.
747:
390:
1311:
1262:
1242:
1100:
1019:
794:
286:
204:
176:
127:
115:
1426:
1306:
365:"Risk factors for gastrointestinal bleeding in critically ill patients"
200:
123:
57:
591:
210:
In surgical critically ill patients, only those patients who are on a
885:
880:
260:
The pathogenic mechanisms are similar to those of erosive gastritis.
196:
184:
147:
73:
430:
524:. Gregory L. Eastwood, M.D.& Canan Avunduk, M.D., Ph.D. (1994)
1301:
987:
751:
273:
bleeding in patients in a medical ICU who require respirators.
715:
Bailey & Love’s SHORT PRACTICE OF SURGERY 23rd
Edition
60:
defect usually caused by physiological (not psychological)
1379:
European
Society of Paediatric and Neonatal Intensive Care
191:, previous gastrointestinal disease and treatment with
1010:
Critical illness–related corticosteroid insufficiency
99:
refers to extreme physiological changes in the body.
1387:
1361:
1325:
1282:
1220:
1136:
1088:
1038:
996:
865:
858:
813:
363:Cook DJ, Fuller HD, Guyatt GH, et al. (1994).
29:
24:
711:
709:
412:Cook DJ, Griffith LE, et al. (Dec 2001).
763:
8:
496:
494:
472:
470:
468:
16:Tissue defect caused by physiological stress
621:
619:
617:
214:for more than 48 hours and/or those with a
862:
770:
756:
748:
476:Hai, A.A. & Shrivastava, R.B. (2003).
21:
439:
429:
380:
118:, stress ulcers are usually found in the
352:
122:and can be located anywhere within the
358:
356:
7:
1258:Recombinant activated protein C
971:Multiple organ dysfunction syndrome
956:Acute respiratory distress syndrome
896:Multiple organ dysfunction syndrome
580:Acta Anaesthesiologica Scandinavica
14:
1369:Society of Critical Care Medicine
1066:Ventilator-associated lung injury
1458:Gastrointestinal tract disorders
68:. These ulcers can be caused by
64:which can become complicated by
46:(upper gastrointestinal surgery)
1071:Ventilator-associated pneumonia
1004:Critical illness polyneuropathy
79:It was previously thought that
66:upper gastrointestinal bleeding
1:
850:Geriatric intensive-care unit
833:Pediatric intensive care unit
502:Pathological Basis of Disease
335:help control the hemorrhage.
1253:Neuromuscular-blocking drugs
1196:Nutritional supplementation
827:Neonatal intensive care unit
684:10.1097/CCM.0b013e3182758734
640:10.1097/CCM.0b013e3181f17adf
1353:Water-electrolyte imbalance
1187:Early goal-directed therapy
382:10.1056/NEJM199402103300601
1474:
1205:Total parenteral nutrition
1138:Life-supporting treatments
845:Critical illness insurance
522:Manual of Gastroenterology
110:are found commonly in the
1374:Surviving Sepsis Campaign
1170:Ventricular assist device
1165:Intra-aortic balloon pump
1116:Pulmonary artery catheter
785:
549:10.1007/s00134-013-3125-3
56:is a single or multiple
44:digestive system surgery
1453:Intensive care medicine
1268:Stress ulcer prevention
1212:Therapeutic hypothermia
1111:Central venous catheter
779:Intensive care medicine
537:Intensive Care Medicine
36:Intensive care medicine
1343:Level of consciousness
1150:mechanical ventilation
1048:Methicillin-resistant
672:Critical Care Medicine
628:Critical Care Medicine
299:proton pump inhibitors
173:hepatic encephalopathy
104:gastrointestinal tract
1050:Staphylococcus aureus
311:Clostridium difficile
212:mechanical ventilator
1025:Stress hyperglycemia
866:Organ system failure
800:Medical specialities
480:. Tata/McGraw-Hill.
291:H2-receptor blockers
1388:Related specialties
1348:Acid–base imbalance
1284:ICU scoring systems
1155:Tracheal intubation
966:Respiratory failure
961:Acute liver failure
951:Acute renal failure
821:Intensive care unit
805:Respiratory therapy
478:Textbook of Surgery
152:respiratory failure
106:. Whereas ordinary
86:Helicobacter pylori
1297:Glasgow Coma Scale
1248:Intravenous fluids
1128:Screening cultures
1096:Arterial blood gas
1061:Refeeding syndrome
978:Neonatal infection
939:Vasodilatory shock
914:Distributive shock
839:Coronary care unit
144:low blood pressure
134:Signs and symptoms
1440:
1439:
1400:Internal medicine
1146:Airway management
1084:
1083:
924:Obstructive shock
909:Cardiogenic shock
592:10.1111/aas.12099
50:
49:
19:Medical condition
1465:
1161:Cardiac devices
1015:Decubitus ulcers
929:Neurogenic shock
863:
772:
765:
758:
749:
742:
739:
733:
730:
724:
713:
704:
703:
666:
660:
659:
623:
612:
611:
575:
569:
568:
531:
525:
519:
513:
498:
489:
474:
463:
460:
454:
453:
443:
433:
409:
403:
402:
384:
360:
246:gastroduodenitis
40:gastroenterology
22:
1473:
1472:
1468:
1467:
1466:
1464:
1463:
1462:
1443:
1442:
1441:
1436:
1383:
1357:
1321:
1278:
1238:Antithrombotics
1216:
1200:Enteral feeding
1182:Kidney dialysis
1132:
1080:
1056:Oxygen toxicity
1034:
992:
854:
809:
781:
776:
746:
745:
740:
736:
731:
727:
714:
707:
668:
667:
663:
625:
624:
615:
577:
576:
572:
533:
532:
528:
520:
516:
499:
492:
475:
466:
461:
457:
411:
410:
406:
362:
361:
354:
349:
341:
321:
282:
270:
258:
242:
233:
228:
193:corticosteroids
160:
136:
20:
17:
12:
11:
5:
1471:
1469:
1461:
1460:
1455:
1445:
1444:
1438:
1437:
1435:
1434:
1429:
1424:
1419:
1418:
1417:
1412:
1407:
1397:
1395:Anesthesiology
1391:
1389:
1385:
1384:
1382:
1381:
1376:
1371:
1365:
1363:
1359:
1358:
1356:
1355:
1350:
1345:
1340:
1335:
1329:
1327:
1323:
1322:
1320:
1319:
1314:
1309:
1304:
1299:
1294:
1292:APACHE II
1288:
1286:
1280:
1279:
1277:
1276:
1271:
1265:
1260:
1255:
1250:
1245:
1240:
1235:
1230:
1224:
1222:
1218:
1217:
1215:
1214:
1209:
1208:
1207:
1202:
1194:
1189:
1184:
1179:
1174:
1173:
1172:
1167:
1159:
1158:
1157:
1142:
1140:
1134:
1133:
1131:
1130:
1125:
1123:Blood cultures
1120:
1119:
1118:
1113:
1108:
1098:
1092:
1090:
1086:
1085:
1082:
1081:
1079:
1078:
1073:
1068:
1063:
1058:
1053:
1044:
1042:
1036:
1035:
1033:
1032:
1027:
1022:
1017:
1012:
1007:
1000:
998:
994:
993:
991:
990:
985:
980:
974:
973:
968:
963:
958:
953:
948:
942:
941:
936:
931:
926:
921:
916:
911:
906:
899:
898:
893:
888:
883:
878:
873:
872:Shock sequence
869:
867:
860:
856:
855:
853:
852:
847:
842:
836:
830:
824:
817:
815:
811:
810:
808:
807:
802:
797:
792:
790:Health science
786:
783:
782:
777:
775:
774:
767:
760:
752:
744:
743:
734:
725:
705:
678:(3): 693–705.
661:
634:(11): 2222–8.
613:
570:
526:
514:
490:
464:
455:
431:10.1186/cc1071
404:
351:
350:
348:
345:
340:
337:
320:
317:
281:
278:
269:
266:
257:
254:
241:
238:
232:
229:
227:
224:
223:
222:
219:
208:
181:kidney failure
159:
156:
135:
132:
112:gastric antrum
48:
47:
33:
27:
26:
18:
15:
13:
10:
9:
6:
4:
3:
2:
1470:
1459:
1456:
1454:
1451:
1450:
1448:
1433:
1430:
1428:
1425:
1423:
1420:
1416:
1413:
1411:
1408:
1406:
1403:
1402:
1401:
1398:
1396:
1393:
1392:
1390:
1386:
1380:
1377:
1375:
1372:
1370:
1367:
1366:
1364:
1362:Organisations
1360:
1354:
1351:
1349:
1346:
1344:
1341:
1339:
1336:
1334:
1331:
1330:
1328:
1324:
1318:
1315:
1313:
1312:SAPS III
1310:
1308:
1305:
1303:
1300:
1298:
1295:
1293:
1290:
1289:
1287:
1285:
1281:
1275:
1272:
1269:
1266:
1264:
1261:
1259:
1256:
1254:
1251:
1249:
1246:
1244:
1241:
1239:
1236:
1234:
1231:
1229:
1226:
1225:
1223:
1219:
1213:
1210:
1206:
1203:
1201:
1198:
1197:
1195:
1193:
1190:
1188:
1185:
1183:
1180:
1178:
1175:
1171:
1168:
1166:
1163:
1162:
1160:
1156:
1153:
1152:
1151:
1147:
1144:
1143:
1141:
1139:
1135:
1129:
1126:
1124:
1121:
1117:
1114:
1112:
1109:
1107:
1106:Arterial line
1104:
1103:
1102:
1099:
1097:
1094:
1093:
1091:
1087:
1077:
1074:
1072:
1069:
1067:
1064:
1062:
1059:
1057:
1054:
1052:
1051:
1046:
1045:
1043:
1041:
1037:
1031:
1028:
1026:
1023:
1021:
1018:
1016:
1013:
1011:
1008:
1005:
1002:
1001:
999:
997:Complications
995:
989:
986:
984:
981:
979:
976:
975:
972:
969:
967:
964:
962:
959:
957:
954:
952:
949:
947:
946:Organ failure
944:
943:
940:
937:
935:
932:
930:
927:
925:
922:
920:
917:
915:
912:
910:
907:
905:
901:
900:
897:
894:
892:
889:
887:
886:Severe sepsis
884:
882:
879:
877:
874:
871:
870:
868:
864:
861:
857:
851:
848:
846:
843:
840:
837:
834:
831:
828:
825:
822:
819:
818:
816:
814:General terms
812:
806:
803:
801:
798:
796:
793:
791:
788:
787:
784:
780:
773:
768:
766:
761:
759:
754:
753:
750:
738:
735:
729:
726:
722:
721:0-340-75949-6
718:
712:
710:
706:
701:
697:
693:
689:
685:
681:
677:
673:
665:
662:
657:
653:
649:
645:
641:
637:
633:
629:
622:
620:
618:
614:
609:
605:
601:
597:
593:
589:
586:(7): 835–47.
585:
581:
574:
571:
566:
562:
558:
554:
550:
546:
542:
538:
530:
527:
523:
518:
515:
511:
507:
503:
497:
495:
491:
487:
483:
479:
473:
471:
469:
465:
459:
456:
451:
447:
442:
437:
432:
427:
424:(6): 368–75.
423:
419:
418:Critical Care
415:
408:
405:
400:
396:
392:
388:
383:
378:
375:(6): 377–81.
374:
370:
366:
359:
357:
353:
346:
344:
338:
336:
332:
328:
324:
318:
316:
314:
312:
307:
302:
300:
296:
292:
288:
279:
277:
274:
267:
265:
261:
255:
253:
249:
247:
239:
237:
230:
225:
220:
217:
213:
209:
206:
202:
198:
194:
190:
186:
182:
178:
174:
170:
169:heart failure
166:
165:
164:
157:
155:
153:
149:
145:
141:
133:
131:
129:
126:and proximal
125:
121:
120:fundic mucosa
117:
113:
109:
108:peptic ulcers
105:
100:
98:
97:
92:
88:
87:
82:
81:peptic ulcers
77:
75:
71:
67:
63:
59:
55:
45:
41:
37:
34:
32:
28:
23:
1432:Traumatology
1333:Hemodynamics
1307:SAPS II
1274:Vasopressors
1192:Induced coma
1049:
1040:Iatrogenesis
1030:Stress ulcer
1029:
934:Spinal shock
891:Septic shock
737:
728:
675:
671:
664:
631:
627:
583:
579:
573:
543:(1): 11–22.
540:
536:
529:
521:
517:
504:6th Edition
501:
477:
458:
421:
417:
407:
372:
369:N Engl J Med
368:
342:
339:Epidemiology
333:
329:
325:
322:
310:
303:
283:
275:
271:
262:
259:
250:
243:
236:hemorrhage.
234:
216:coagulopathy
189:hypertension
161:
158:Risk factors
137:
101:
95:
91:stress ulcer
90:
84:
78:
54:stress ulcer
53:
51:
25:Stress ulcer
1415:Pulmonology
1338:Hypotension
1233:Antibiotics
1076:Dialytrauma
919:Anaphylaxis
1447:Categories
1422:Pediatrics
1405:Cardiology
1326:Physiology
1228:Analgesics
1177:Chest tube
1006:/ myopathy
983:Polytrauma
859:Conditions
510:8178670526
486:0074621491
347:References
295:sucralfate
280:Prevention
226:Mechanisms
140:hemoglobin
1410:Neurology
1263:Sedatives
1243:Inotropes
1089:Diagnosis
319:Treatment
306:pneumonia
268:Diagnosis
256:Formation
31:Specialty
1101:Catheter
1020:Fungemia
795:Medicine
723:page 916
692:23318494
656:17819100
648:20711074
608:36997236
600:23495933
565:24990932
557:24141808
500:Robbins
488:, p. 409
450:11737927
399:76019212
287:antacids
231:Location
205:warfarin
177:jaundice
128:duodenum
116:duodenum
114:and the
1427:Surgery
700:8138473
391:8284001
313:colitis
240:Lesions
201:heparin
124:stomach
58:mucosal
902:Other
881:Sepsis
835:(PICU)
829:(NICU)
719:
698:
690:
654:
646:
606:
598:
563:
555:
512:p. 796
508:
484:
448:
438:
397:
389:
297:, and
197:NSAIDS
185:stroke
150:, and
148:sepsis
96:stress
74:sepsis
62:stress
1270:drugs
1221:Drugs
904:shock
841:(CCU)
823:(ICU)
696:S2CID
652:S2CID
604:S2CID
561:S2CID
441:83859
395:S2CID
203:, or
70:shock
1317:SOFA
1302:PIM2
1148:and
988:Coma
876:SIRS
717:ISBN
688:PMID
644:PMID
596:PMID
553:PMID
506:ISBN
482:ISBN
446:PMID
387:PMID
308:and
680:doi
636:doi
588:doi
545:doi
436:PMC
426:doi
377:doi
373:330
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