Stress Ulcer Prophylaxis

A stress Ulcer is an ulceration of the upper gastrointestinal tract due to hospitalization. Hemorrhage from stress ulceration is secondary GI bleeding and it is different from primary GI bleeding. Primary prevention of GI bleeding from stress ulcers is known as stress ulcer prophylaxis.

Guidelines for Stress Ulcer Prophylaxis

Stress ulcer prophylaxis has historically been a disease process with a high degree of prevalence in the setting of burns and trauma. Stress Ulcer Prophylaxis is directed to critically ill patients for the prevention of stress-related mucosal bleeding from the upper gastrointestinal tract.

Causes of Stress Ulcer

Stress ulcer is similar to Peptic ulcer but it is made worse due to stress. It causes inflammation in the intestine and stomach lining. Stress ulcers come on suddenly, as a result of psychological and emotional stress. Some acidic foods can also worsen the symptoms of Stress ulcers.

The Risk Factors of Stress Ulcer

• H. pylori infection
• Use of NSAIDs
• People with serious ulcers are also more likely to develop stress ulcers.

What are the Symptoms of Stress Ulcer?

• Pain in the upper stomach
• The pain gets better or worst with foods
• Bloatedness/unusually full
• Vomiting and nausea
• Symptoms of anemia
• Shortness of breath and pale skin

Stress ulcers can cause severe bleeding or blood loss and they can be life-threatening. Seek medical help right away when you experience:

• Red vomit that is similar to coffee grounds
• Maroon or reddish bowel movements
• Tarry and dark bowel movements
• Fainting and lightheadedness

How to Diagnose Stress Ulcer

The doctor will make a thorough assessment of your health history. You can also diagnose stress ulcers through endosopy to see the gastrointestinal tract. Blood, urine, and stool testing can also help in determining ulcers to check for H.pylori bacteria. Medical providers also use imaging tests such as X-rays, ultrasound, and CT-scan.

Treatment of Stress Ulcer

Acid reducers, proton pump inhibitors, and H2 blockers are typical medications for ulcers. Your doctor may also recommend surgeries and treatment options depending on the severity of the case.

What are the risk factors for stress ulcer development and which patients require Prophylaxis?

Level 1 recommendations. Prophylaxis is recommended for all patients with:

• Coagulopathy
• Traumatic brain injury
• Mechanical ventilation
• Major burn injury

Level 2 recommendations. Prophylaxis is recommended for all ICU patients with:

• Multi-trauma
• Sepsis
• Acute renal failure

Level 3 recommendations. Prophylaxis is recommended for all ICU patients with:

• ISS>15
• Requirement of high-dose steroids