Stress Ulcer Prophylaxis

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There’s a good chance you’re familiar with peptic ulcers, ulcerations that occur in the digestive tract, particularly the stomach and upper portion of the small intestines, but you may know less about stress ulcers. A stress ulcer is an ulceration in the digestive tract primarily affects people who are seriously ill in the hospital, especially those in the intensive care unit.

Because stress ulcers can lead to complications such as bleeding, doctors take steps to prevent these ulcers in patients are sick. What types of stress ulcer prophylaxis help to prevent this potentially life-threatening problem?

How Common are Stress Ulcers?

Stress ulcers occur in 3 out of every 200 patients in the intensive care unit, usually in those with serious medical conditions such as heart, lung or kidney failure - and people on mechanical respirators. The problem with stress ulcers is they bleed, and when they do, it causes rapid drops in hemoglobin, which leads to shock. As you can imagine, a seriously ill patient in the I.C.U. doesn’t need a problem like this, and stress ulcers significantly increase the risk of mortality.

Stress Ulcer Prophylaxis: Who Gets It?

Not every patient who enters the hospital or even the intensive care unit gets stress ulcer prophylaxis. Doctors usually reserve it for patients who are seriously ill and at high risk for stress ulcers - usually those in the intensive care unit. If a patient requires mechanical ventilation using a respirator for more than 2 days or is at greater risk of bleeding due to platelet abnormalities or abnormal clotting factors, he or she should receive prophylaxis.

Also, patients with more than one serious medical problem, particularly those with organ failure, need stress ulcer prophylaxis as do patients who are on medications that irritate the stomach lining or increase the risk of bleeding. Not surprisingly, patients with a history of a peptic ulcer in the past would also be at higher risk and need prophylaxis.

What Type of Prophylaxis Do Doctors Use to Prevent Stress Ulcers?

Doctors prescribe medications that block the secretion of acid by cells in the stomach. These medications fall into two classes, H2-antagonists and proton-pump inhibitors, or PPI’s. These medications aren’t without side effects. Studies show that they increase the risk of certain types of pneumonia and the risk of infection with a bacteria called Clostridium difficile. As a result, doctors like to use them only in patients at high-risk for a stress ulcer such as people in the intensive care unit and those with head injuries or burns.

Another medication used less frequently for stress ulcer prophylaxis is sucralfate, a medication that forms a protective coating in the stomach that blocks the effects of stomach acid.

The Bottom Line?

Stress ulcer prophylaxis is usually only used in hospitalized patients that are seriously ill and at high risk for stress-related ulcers because of the risk of side-effects such as pneumonia. On the other hand, they can potentially prevent a stress ulcer from forming in a critically ill patient. In a case like this, they can be life-saving.

References “Stress Ulcer Prophylaxis in Hospitalized Patients: Current Guidelines”. “Stress Ulcer Prophylaxis in Hospitalized Patients: Complications of Gastric Acid Suppressant Use”

Merck Manual. Eighteenth edition. 2006.