Gastric Bleeding and/or (?) Enteral Feeding

Abstract

Upper gastrointestinal bleeding from stress ulceration is a serious complication of critical illness which is associated with increased morbidity and mortality. 1 Zinner MJ Zuidema GD Smith PL Mignosa M The prevention of upper gastrointestinal tract bleeding in patients in an intensive care unit. Surg Gynecol Obstet. 1981; 153: 214-220 PubMed Google Scholar , 2 Harris (Pingleton) SK Bone RC Ruth WE Gastrointestinal hemorrhage in patients in a respiratory intensive care unit. Chest. 1977; 72: 301-304 Abstract Full Text Full Text PDF PubMed Scopus (69) Google Scholar , 3 Schuster DP Rowley H Feinstein S McGue MK Zukerman GR Prospective evaluation of the risk of upper gastrointestinal bleeding after admission to a medical intensive care unit. Am J Med. 1984; 76: 623-630 Abstract Full Text PDF PubMed Scopus (191) Google Scholar Efforts to prevent gastric bleeding have centered on prevention of stress ulceration. Stress ulcers are caused by a complex interaction of systemic, tissue and luminal factors which destroy the ability of the intact gastric mucosa to maintain homeostasis. 4 Silen W Pathogenetic factors in erosive gastritis. Am J Med. 1985; 79: 45-48 Abstract Full Text PDF PubMed Scopus (22) Google Scholar Preservation of gastric mucosal integrity is a dynamic process dependent upon normal gastric blood flow, systemic acid-base balance and normal metabolic and secretory state of the mucosa. Experimental evidence suggests gastric acid plays a key role in the formation of gastric erosions, not from excessive acid secretion, but rather from a temporary failure of gastric mucosal defense mechanisms to deal with the acid present. 5 Marrone GC Silen W Pathogenesis, diagnosis and treatment of acute gastric mucosal lesions. Clin Gastroenterology. 1984; 13: 635-649 PubMed Google Scholar Therefore, prophylactic measures have centered on neutralizing gastric acidity with antacids and decreasing gastric acid secretion with histamine2-receptor blockers, such as cimetidine or ranitidine. An array of clinical studies suggest antacids are superior in elevating gastric pH and decreasing gastric bleeding. 1 Zinner MJ Zuidema GD Smith PL Mignosa M The prevention of upper gastrointestinal tract bleeding in patients in an intensive care unit. Surg Gynecol Obstet. 1981; 153: 214-220 PubMed Google Scholar , 2 Harris (Pingleton) SK Bone RC Ruth WE Gastrointestinal hemorrhage in patients in a respiratory intensive care unit. Chest. 1977; 72: 301-304 Abstract Full Text Full Text PDF PubMed Scopus (69) Google Scholar , 6 Priebe HJ Skillman JJ Bushnell LS Long PC Silen W Antacid versus cimetidine in preventing acute gastrointestinal bleeding. N Engl J Med. 1980; 302: 426-430 Crossref PubMed Scopus (263) Google Scholar , 7 Martin LF Staloch DK Simonwitz DA Failure of cimetidine prophylaxis in the critically ill. Arch Surg. 1979; 114: 492-496 Crossref PubMed Scopus (42) Google Scholar However, recent data indicate that cimetidine may prevent progression of established stress ulceration. 8 Peura DA Johnson LF Cimetidine for prevention and treatment of gastroduodenal mucosal lesions in patients in an intensive care unit. Ann Intern Med. 1985; 103: 173-177 Crossref PubMed Scopus (154) Google Scholar