Prevention
The need for medications to prevent stress ulcer among those in the intensive care unit is unclear. As of 2014, the quality of the evidence is poor. It is unclear which agent is best or if prevention is needed at all. Benefit may only occur in those who are not being fed. Possible agents include antacids, H2-receptor blockers, sucralfate, and proton pump inhibitors (PPIs). Tentative evidence supports that PPIs may be better than H2 blockers.Concerns with the use of stress ulcer prophylaxis agents include increased rates of pneumonia and Clostridium difficile colitis. Treatment
The principles of management are the same as for the chronic ulcer. The steps of management are similar as in erosive gastritis.Endoscopic means of treating stress ulceration may be ineffective and operation required. It is believed that shunting blood away from the mucosa makes the mucous membrane ischaemic and more susceptible to injury.Treatment of stress ulceration usually begins with prevention. Careful attention to respiratory status, acid-base balance, and treatment of other illnesses help prevent the conditions under which stress ulcers occur. Patients who develop stress ulcers typically do not secrete large quantities of gastric acid; however, acid does appear to be involved in the pathogenesis of the lesions. Thus it is reasonable either to neutralize acid or to inhibit its secretion in patients at high risk.In case of severe hemorrhagic or erosive gastritis and stress ulcers, a combination of antacids and H2-blockers may stop active bleeding and prevent bleeding from happening again.
In selected patients, either endoscopic therapy or selective infusion of vasopressin into the left gastric artery may help control the hemorrhage. Epidemiology
Among those in the intensive care unit, ulceration resulting in bleeding is very rare. == References ==