[Gastrointestinal stress ulcer: still a typical intensive care complication or a vanishing disease?]

Abstract

Stress-induced hemorrhage from gastroduodenal lesions is a serious complication in critically ill patients. An analysis of the studies published in recent years shows, that the incidence of "clinically relevant bleedings" decreased over the past 15 years. Beside a medicinal prophylaxis of stress lesions, the general improvements in critical care, like all measures to prevent stress, the early treatment of shock states, sufficient oxygenation and early enteral nutrition as well as the improvements in nursing care are responsible for the reduction of the incidence. Those in danger of "clinically relevant bleedings" are as a rule patients with one or more predisposing factors. These factors are conditions of hypotension, various forms of shock, hypoxia, respiratory failure, hepatic and renal failure, coagulopathies and the treatment with steroids and nonsteroidal antiinflammatory drugs. Only for these critically ill patients a medicinal prophylaxis of stress lesions in justified and sensible.