Stress Ulceration

Often evident within 24h.
90% by day 3 with no prophylaxis.
Clinically important bleeding 1.5% with mortality x4.
Major risk factors are:
Prolonged mechanical ventilation (>48h) and coagulopathy.
Also:
Associations include burns, trauma, renal failure, heart failure.

Pathogenesis
↑ acid production from parietal cells (↓ PG production)
↓ mucous production
↓ mucosal blood flow

Prevention
Maximisation of DO2
Enteral feeding
Sucralfate

  • Binds preferentially to ulcers providing physical barrier to acid
H2 antagonists - Ranitidine
PPIs

PPIs better than H2 antagonists at reducing acidity but no difference in clinically significant bleeding.
Tolerance develops to H2s.
H2 antagonists and PPIs → ↑ VAP