Misoprostol is a Preventing stress ulcers analog Pdeventing selectively inhibits acid secretion as well Energy drinks with vitamins enhances mucosal Prevrnting mechanisms. Peeventing Care Compendium. Patients must speak Preventin a health care provider for complete information about their health, medical questions, and treatment options, including any risks or benefits regarding use of medications. On balance, evidence favors PPIs based upon meta-analyses that report possible superiority of PPIs in the reduction of clinically important GI bleeding compared with H2 blockers.

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How do we prevent Stomach Ulcers? How dangerous can it be? What is the treatment for stomach ulcers?

Preventing stress ulcers -

However, more recent data suggests that the incidence of clinically significant hemorrhage is decreasing over time. It has become standard of care for patients to receive chemical stress ulcer prophylaxis if requiring mechanical ventilation, having coagulopathy, or suffering traumatic brain injury or major burns.

More recently, need for prophylaxis and medication of choice have come into question. With increasing popularity of proton pump inhibitors PPI as stress ulcer prophylaxis, concerns have risen regarding the risks of infection complications, such as C. difficile colitis and nosocomial pneumonia.

While no randomized trials have suggested a causative link between stress ulcer prophylaxis and infectious complications, several observational studies suggest such a correlation.

H2-receptor antagonists are commonly used and have shown similar efficacy in preventing clinically significant GI bleeding. Sulcralfate is less commonly used, yet is thought to be equally efficacious in preventing stress ulcer formation and bleeding.

An ongoing, large, multicenter trial Re-Evaluating the Inhibition of Stress Erosions, REVISE comparing placebo to pantoprazole is currently underway which should help inform future practice.

Overall, mostly low quality data regarding these topics exists begging the need for a large multi-center randomized trial to help clarify these questions. Studies were limited to prospective randomized trials published with the last 10 years since the EAST guideline upon with the last UTH guideline was based.

Actual costs cannot be displayed. However, the costs of different regimens are provided in the form of multiples of the cost of famotidine. So, some hospitals give patients medications to prevent ulcers and routinely check for them.

Strategies for preventing stress ulcers are similar to those for treating the ulcers; PPIs and histamine blockers may reduce the risk of stress ulcers. A Cleveland Clinic Journal of Medicine review cautions that there is no reason to give all hospitalized patients preventive treatment.

Unnecessary preventive treatment increases costs and complications. The American Society of Health System Pharmacists recommend preventive treatment for patients who meet any of the following criteria :.

In the past, doctors told people with a history of ulcers to eat a bland diet. New research shows that this is not necessary. Spicy foods do not cause ulcers, though some people notice that their symptoms get worse after eating certain foods.

People at risk of developing stress ulcers often have serious health issues, such as infections, organ failure, or head injuries. A stress ulcer can cause serious inflammation and bleeding that complicates other conditions.

This means that stress ulcers are more dangerous than traditional peptic ulcers. Most people at risk of developing stress ulcers are already in the hospital.

If a person has recently had a hospital stay and develops symptoms of an ulcer, they should contact a doctor right away. Not all serious ulcers immediately cause serious symptoms, so it is important for a doctor to assess any ulcer symptoms that arise. When ulcers rapidly bleed, a person can experience life-threatening blood loss.

This can make healing difficult. With the right treatment, however, people can recover from both stress ulcers and the issues that cause them.

Ulcers usually occur due to bacteria or are a side effect of nonsteroidal anti-inflammatory drugs. Learn more about causes and how diet can help…. Some people claim that the alkaline diet helps with weight loss and disease, but there are few studies to back up these claims.

Learn more about the…. Ulcers can occur in many places, including in the stomach. These are called stomach or peptic ulcers. People can try home remedies to relieve the…. What are the symptoms of peptic ulcers? Find out here along with information on the most common causes and effective treatments for peptic ulcers.

Escherichia coli E. coli , specifically the OH7 strain, is a bacteria species responsible for causing hemorrhagic gastroenteritis. Learn more…. My podcast changed me Can 'biological race' explain disparities in health? Why Parkinson's research is zooming in on the gut Tools General Health Drugs A-Z Health Hubs Health Tools Find a Doctor BMI Calculators and Charts Blood Pressure Chart: Ranges and Guide Breast Cancer: Self-Examination Guide Sleep Calculator Quizzes RA Myths vs Facts Type 2 Diabetes: Managing Blood Sugar Ankylosing Spondylitis Pain: Fact or Fiction Connect About Medical News Today Who We Are Our Editorial Process Content Integrity Conscious Language Newsletters Sign Up Follow Us.

Medical News Today. Health Conditions Health Products Discover Tools Connect. A comparison of the frequency of stress ulceration and secondary pneumonia in sucralfate- or ranitidine-treated intensive care unit patients. Ephgrave KS, Kleiman-Wexler R, Pfaller M, et al. Effects of sucralfate vs antacids on gastric pathogens: results of a double-blind clinical trial.

Arch Surg ; Fabian TC, Boucher BA, Croce MA, et al. Arch Surg ;; discussion Faisy C, Guerot E, Diehl JL, et al. Intensive Care Med ; Geus WP, Vinks AA, Smith SJ, et al.

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Intensive Care Med ;­ Hanisch EW, Encke A, Naujoks F, et al. Am J Surg ; Heiselman DE, Hulisz DT, Fricker R, et al. Kantorova I, Svoboda P, Scheer P, et al.

Stress ulcer prophylaxis in critically ill patients: a randomized controlled trial. Hepatogastroenterology ; Kitler ME, Hays A, Enterline JP, et al. Preventing postoperative acute bleeding of the upper part of the gastrointestinal tract.

Surg Gynecol Obstet ;­ Lasky MR, Metzler MH, Phillips JO. J Trauma ; Laterre PF, Horsmans Y. Levy MJ, Seelig CB, Robinson NJ, et al. Comparison of omeprazole and ranitidine for stress ulcer prophylaxis.

Maier RV, Mitchell D, Gentilello L. Optimal therapy for stress gastritis. Ann Surg ;; discussion Martin LF, Booth FV, Karlstadt RG, et al.

Martin LF, Booth FV, Reines HD, et al. Stress ulcers and organ failure in intubated patients in surgical intensive care units. Ann Surg ; Metz CA, Livingston DH, Smith JS, et al. Impact of multiple risk factors and ranitidine prophylaxis on the development of stress-related upper gastrointestinal bleeding: a prospective, multicenter, double-blind, randomized trial.

The Ranitidine Head Injury Study Group. Mulla H, Peek G, Upton D, et al. Mustafa NA, Akturk G, Ozen I, et al. Acute stress bleeding prophylaxis with sucralfate versus ranitidine and incidence of secondary pneumonia in intensive care unit patients. Pemberton LB, Schaefer N, Goehring L, et al.

Phillips JO, Metzler MH, Palmieri MT, et al. Phillips JO, Olsen KM, Rebuck JA, et al. A randomized, pharmacokinetic and pharmacodynamic, cross-over study of duodenal or jejunal administration compared to nasogastric administration of omeprazole suspension in patients at risk for stress ulcers.

Pickworth KK, Falcone RE, Hoogeboom JE, et al. Pimentel M, Roberts DE, Bernstein CN, et al. Prod'hom G, Leuenberger P, Koerfer J, et al. A randomized controlled trial. Ruiz-Santana S, Ortiz E, Gonzalez B, et al. Stress-induced gastroduodenal lesions and total parenteral nutrition in critically ill patients: frequency, complications, and the value of prophylactic treatment.

A prospective, randomized study. Ryan P, Dawson J, Teres D, et al. Nosocomial pneumonia during stress ulcer prophylaxis with cimetidine and sucralfate. Simms HH, DeMaria E, McDonald L, et al. Role of gastric colonization in the development of pneumonia in critically ill trauma patients: results of a prospective randomized trial.

J Trauma ;; discussion Simons RK, Hoyt DB, Winchell RJ, et al. A risk analysis of stress ulceration after trauma. Thomason MH, Payseur ES, Hakenewerth AM, et al. Nosocomial pneumonia in ventilated trauma patients during stress ulcer prophylaxis with sucralfate, antacid, and ranitidine.

Zandstra DF, Stoutenbeek CP. The virtual absence of stress-ulceration related bleeding in ICU patients receiving prolonged mechanical ventilation without any prophylaxis. Zeltsman D, Rowland M, Shanavas Z, et al.

Is the incidence of hemorrhagic stress ulceration in surgical critically ill patients affected by modern antacid prophylaxis? Am Surg ; Devlin JW, Claire KS, Dulchavsky SA, et al.

Pharmacotherapy ; Oxman AD. Checklists for review articles. BMJ ; Eastern Association for the Surgery of Trauma, EAST Ad Hoc Committee on Practice Management Guideline Development. Maynard N, Bihari D, Beale R, et al. Assessment of splanchnic oxygenation by gastric tonometry in patients with acute circulatory failure.

JAMA ;­ Cook DJ, Reeve BK, Guyatt GH, et al. Stress ulcer prophylaxis in critically ill patients. Resolving discordant meta-analyses. JAMA ; Merki HS, Wilder-Smith CH. Do continuous infusions of omeprazole and ranitidine retain their effect with prolonged dosing?

Gastroenterology ; Netzer P, Gut A, Heer R, et al. Five-year audit of ambulatory hour esophageal pH-manometry in clinical practice. Scand J Gastroenterol ; Wilson P, Clark GW, Anselmino M, et al.

Comparison of an intravenous bolus of famotidine and Mylanta II for the control of gastric pH in critically ill patients. Am J Surg ;; discussion Mallow S, Rebuck JA, Osler T, et al. Do proton pump inhibitors increase the incidence of nosocomial pneumonia and related infectious complications when compared with histamine-2 receptor antagonists in critically ill trauma patients?

Curr Surg ; Tryba M, Kurz-Muller K, Donner B. Plasma aluminum concentrations in long-term mechanically ventilated patients receiving stress ulcer prophylaxis with sucralfate.

Allen ME, Kopp BJ, Erstad BL. Stress ulcer prophylaxis in the postoperative period. Am J Health Syst Pharm ; Cash BD. Evidence-based medicine as it applies to acid suppression in the hospitalized patient.

Crit Care Med ;S Jung R, MacLaren R. Proton-pump inhibitors for stress ulcer prophylaxis in critically ill patients. Table First author Year Reference title Reference Baghaie AA Comparison of the effect of intermittent administration and continuous infusion of famotidine on gastric pH in critically ill patients: results of a prospective randomized crossover study.

Crit Care Med. Study design Class of data for article Prospective crossover study on 15 patients comparing gastric pH during continuous and bolus famotidine administration 2 Questions Class of data for question What are the risk factors for stress ulcer development and which trauma patients require prophylaxis?

Did not address this question Is there a preferred agent for stress ulcer prophylaxis? If so, what? Did not address this question What is the appropriate duration for stress ulcer prophylaxis in this population?

Did not address this question Comments Continuous infusion is more effective than intermittent dosages in maintaining the "appropriate gastric pH" necessary for SUP First author Year Reference title Reference Balaban DH Nasogastric omeprazole: effects on gastric pH in critically ill patients.

Am J Gastroenterol. Study design Class of data for article Prospective, non-randomized on 10 medical ICU patients, looking at effects of omeprazole and ranitidine on gastric pH. Yes, omeprazole 2 What is the appropriate duration for stress ulcer prophylaxis in this population?

First author Year Reference title Reference Ben Menachem T Prophylaxis for stress-related gastric hemorrhage in the MICU Ann Intern Med.

Study design Class of data for article Prospective, randomized, single-blind trial on patients in the MICU comparing placebo, oral sucralfate, or IV infusion of ranitidine.

Respiratory failure, shock, sepsis, cardiac arrest, liver failure, ARF, coagulopathy, pancreatitis, high-dose steroids, anticoagulation 2 Is there a preferred agent for stress ulcer prophylaxis? No difference between cimetidine, sucralfate, and placebo 1 What is the appropriate duration for stress ulcer prophylaxis in this population?

Comments Medical patients only. First author Year Reference title Reference Bonten MJ Continuous enteral feeding counteracts preventive measures for gastric colonization in ICU patients Crit Care Med. Study design Class of data for article Prospective, non-randomized trial eval change in gastric pH with 2 Questions Class of data for question What are the risk factors for stress ulcer development and which trauma patients require prophylaxis?

No 2 What is the appropriate duration for stress ulcer prophylaxis in this population? Did not address this question. Comments Sucralfate with topical ABX was equivalent to STD prophylaxis in prevention of gastric colonization unless pt received enteral feeding.

First author Year Reference title Reference Bonten MJ The role of intragastric acidity and stress ulcer prophylaxis on colonization and infection in mechanically ventilated ICU patients.

Am J Respir Crit Care Med. Study design Class of data for article Single center RCT comparing antacids vs sucralfate, pts, stratified by gastric pH.

Mechanical ventilation 1 Is there a preferred agent for stress ulcer prophylaxis? No difference between sucralfate and antacids 2 What is the appropriate duration for stress ulcer prophylaxis in this population? Did not address this question Comments VAP rates, mortality rates, and gastric colonization rates were all similar.

First author Year Reference title Reference Burgess P Effect of ranitidine on intragastric pH and stress related upper gastrointestinal bleeding in patients with severe head injury Dig Dis Sci.

Study design Class of data for article Single center, RCT,34 patients with traumatic brain injury. Yes, ranitidine 1 What is the appropriate duration for stress ulcer prophylaxis in this population?

First author Year Reference title Reference Conrad SA Randomized, double-blind comparison of immediate-release omeprazole oral suspension versus intravenous cimetidine for the prevention of upper gastrointestinal bleeding in critically ill patients.

Study design Class of data for article RCT, multi-institutional, pts. Yes, omeprazole 1 What is the appropriate duration for stress ulcer prophylaxis in this population? Comments Omeprazole oral superior to cimetidine IV at preventing any overt GIB, noninferior to cimetidine in prevention of clinically significant bleeding.

First author Year Reference title Reference Cook D A comparison of sucralfate and ranitidine for the prevention of upper gastrointestinal bleeding in patients requiring mechanical ventilation.

N Engl J Med. Comparison sucralfate with ranitidine. Outcome: GIB. Comments Ranitidine superior to sucralfate in prevention of GIB in the ventilated ICU patients. First author Year Reference title Reference Cook D Risk factors for clinically important upper gastrointestinal bleeding in patients requiring mechanical ventilation.

Study design Class of data for article Multicenter RCT, pts. Comparison: ranitidine IV vs sucralfate. Thrombocytopenia, ARF, MOD, NPO 2 Is there a preferred agent for stress ulcer prophylaxis?

Ranitidine 1 What is the appropriate duration for stress ulcer prophylaxis in this population? Did not address this question Comments Ranitidine superior to sucralfate for GIB prevention. Enteral nutrition is protective.

First author Year Reference title Reference Cook DJ The attributable mortality and length of ICU stay of clinically important gastrointestinal bleeding in critically ill patients. Crit Care. Epub Oct 5. Study design Class of data for article Retrospective study MICU pts, outcome of ICU LOS and GIB 3 Questions Class of data for question What are the risk factors for stress ulcer development and which trauma patients require prophylaxis?

Mechanical ventilation 2 Is there a preferred agent for stress ulcer prophylaxis? Did not address this question Comments GIB increases mortality and ICU length of stay. Recommended selective prophylaxis. First author Year Reference title Reference Cook DJ Risk factors for gastrointestinal bleeding in critically ill patients.

Study design Class of data for article Retrospective study, single center, pts. Comparison: GIB vs no GIB. Respiratory failure, shock, sepsis, cardiac arrest, liver failure, ARF, coagulopathy, pancreatitis, high-dose steroids, organ transplantation, anticoagulation 3 Is there a preferred agent for stress ulcer prophylaxis?

When risk factors are no longer present 2 Comments Most important risk factors or mechanical ventilation greater than 48 hours and coagulopathy. First author Year Reference title Reference Devlin JW Stress ulcer prophylaxis in MICU patients: annual utilization in relation to the incidence of endoscopically proven stress ulceration.

Ann Pharmacother. Study design Class of data for article Retrospective study of MICU patients, single institution. No prophylaxis is necessary 3 What is the appropriate duration for stress ulcer prophylaxis in this population? Did not address this question Comments MICU study showing that selective prophylaxis does not increase endoscopic GIB First author Year Reference title Reference Devlin JW Impact of trauma stress ulcer prophylaxis guidelines on drug cost and frequency of major gastrointestinal bleeding Pharmacother apy.

Study design Class of data for article single center, retrospective, non-randomized, patients. TBI, SCI, coagulopathy, mech vent, postop with NGT, PUD last 6 mos, gastric tonometry, MD preference 3 Is there a preferred agent for stress ulcer prophylaxis? Yes, cimetidine 3 What is the appropriate duration for stress ulcer prophylaxis in this population?

Did not address this question Comments Discontinue after pt. First author Year Reference title Reference Eddleston J A comparison of frequency of stress ulceration and secondary pneumonia in sucralfate-or ranitidine-treated intensive care unit patients Crit Care Med.

Study design Class of data for article Single center RCT, 60 patients. SICU pts with mech vent and high risk for stress ulceration 2 Is there a preferred agent for stress ulcer prophylaxis?

Yes, sucralfate 1 What is the appropriate duration for stress ulcer prophylaxis in this population? Did not address this question Comments Gastric pH, colonization, and VAP increased with ranitidine, sucralfate recommended.

bleeding complications. First author Year Reference title Reference Eddleston JM Prospective endoscopic study of stress erosions and ulcers in critically ill adult patients treated with either sucralfate or placebo.

Study design Class of data for article Prospective RCT, single institution. Sucralfate 1 What is the appropriate duration for stress ulcer prophylaxis in this population?

Did not address this question Comments Small study showing decrease endoscopic pathology with sucralfate. First author Year Reference title Reference Ephgrave KS Effects of sucralfate versus antacids on gastric pathogens: results of a double-blind clinical trial.

Arch Surg. Study design Class of data for article Single center RCT comparing sucralfate vs antacids of VA patients undergoing major surgery requiring NGT. No difference between sucralfate and antacids 1 What is the appropriate duration for stress ulcer prophylaxis in this population?

Did not address this question Comments No difference in pneumonia or GIB between the study groups. First author Year Reference title Reference Fabian, TC Pneumonia and stress ulceration in severely injured patients.

A prospective evaluation of the effects of stress ulcer prophylaxis Arch Surg. Study design Class of data for article Single center RCT, trauma patients.

Spinal cord injury 2 Is there a preferred agent for stress ulcer prophylaxis? No difference between cimetidine and sucralfate 2 What is the appropriate duration for stress ulcer prophylaxis in this population?

Discontinued with discharge or death, minimum of 3 days. Intensive Care Med. Epub Jun Study design Class of data for article Single-center retrospective study, pts.

Comparison: prophylaxis vs no prophylaxis. Mechanical ventilation greater than 48 hours, coagulopathy and acute renal failure 3 Is there a preferred agent for stress ulcer prophylaxis? Did not address this question Comments No difference in GIB with and without prophylaxis. Recommended further study.

First author Year Reference title Reference Geus WP Comparison of two IV ranitidine regimens in a homogenous population of ICU patients. Aliment Pharmacol Ther.

Study design Class of data for article Single center RCT comparing infusion vs bolus ranitidine, 18 pts. Outcome measures: gastric pH 1 Questions Class of data for question What are the risk factors for stress ulcer development and which trauma patients require prophylaxis?

Yes, ranitidine 3 What is the appropriate duration for stress ulcer prophylaxis in this population? Did not address this question Comments No difference between infusion vs bolus ranitidine.

First author Year Reference title Reference Gurman G The rate of gastrointestinal bleeding in a general ICU population: a retrospective study.

Study design Class of data for article Retrospective study patients. Am J Surg. Study design Class of data for article Single center, RCT, patients. Comparison: placebo, ranitidine, pirenzepine. Outcome: VAP. SICU and mechanically ventilated 2 Is there a preferred agent for stress ulcer prophylaxis?

Did not address this question Comments No difference between ranitidine and pirenzepine with regard to VAP. First author Year Reference title Reference Heiselman DE Randomized comparison of gastric pH control with intermittent and continuous intravenous infusion of famotidine in ICU patients.

Study design Class of data for article Singe center RCT, 40 patients. Comparison: continuous vs bolus famotidine. Famotidine bolus followed by infusion 1 What is the appropriate duration for stress ulcer prophylaxis in this population?

Did not address this question Comments No statistical difference in GI bleed, and hospital mortality. First author Year Reference title Reference Kantorova I Stress ulcer prophylaxis in critically ill patients: a randomized controlled trial.

Hepatogastroe nterology. Study design Class of data for article Single center RCT, patients. Coagulopathy 1 Is there a preferred agent for stress ulcer prophylaxis?

No 1 What is the appropriate duration for stress ulcer prophylaxis in this population? Did not address this question Comments No difference between any treatment arm and GIB, pneumonia.

First author Year Reference title Reference Kitler ME Preventing postoperative acute bleeding of the upper part of the gastrointestinal tract Surg Gynecol Obstet. Study design Class of data for article Prospective randomized trial, pts in the ICU comparing bioflavonoid, sucralfate, and Maalox.

Did not address this question Comments No difference in the bleeding based on the various treatments. First author Year Reference title Reference Lasky MR A prospective study of omeprazole suspension to prevent clinically significant gastrointestinal bleeding from stress ulcers in mechanically ventilated trauma patients J Trauma.

Study design Class of data for article Single center, retrospective study, 60 pts. Yes, omeprazole 3 What is the appropriate duration for stress ulcer prophylaxis in this population?

Ulcfrs reduce Electrolytes and endurance frequency ulcerd overt GI atress in ICU Preventing stress ulcers compared to placebo or no prophylaxis. Enteral strrss protects against Preventing stress ulcers ulcers, but it is uncertain if withholding stress ulcer prophylaxis from patients who are at high risk for gastrointestinal bleeding is appropriate. Barkun AN, Bardou M, Pham CQ, Martel M. Proton pump inhibitors vs. histamine 2 receptor antagonists for stress-related mucosal bleeding prophylaxis in critically ill patients: a meta-analysis. Am J Gastroenterol. doi: CLINICAL Preventiing. Acid Preventing stress ulcers therapy Skin care tips commonly used Preventing stress ulcers gastrointestinal GI prophylaxis in tsress systems. More recently, concern has grown over the widespread overuse of acid-suppressive agents for stress ulcer prophylaxis in health systems. Stress ulceration can occur after trauma, surgery, organ failure, sepsis, or thermal injury. Thus, acid suppression therapy can play an important role in the prevention of GI stress ulcers in certain hospitalized patients.