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stress ulcer wikipedia jump to content main menu main menu move to sidebar hide navigation main page contents current events random article about wikipedia contact us contribute help learn to edit community portal recent changes upload file special pages search search appearance donate create account log in personal tools donate create account log in contents move to sidebar hide top 1 signs and symptoms 2 risk factors 3 mechanisms toggle mechanisms subsection 3 1 location 3 2 lesions 3 3 formation 4 diagnosis 5 prevention 6 treatment 7 epidemiology 8 references toggle the table of contents stress ulcer 3 languages العربية bahasa indonesia ไทย edit links article talk english read edit view history tools tools move to sidebar hide actions read edit view history general what links here related changes upload file permanent link page information cite this page get shortened url switch to legacy parser print export download as pdf printable version in other projects wikidata item appearance move to sidebar hide from wikipedia the free encyclopedia redirected from stress ulcer prevention tissue defect caused by physiological stress medical condition stress ulcer specialty intensive care medicine gastroenterology digestive system surgery upper gastrointestinal surgery a stress ulcer is defined as ulceration in the upper gi tract as a result of hospitalization which can become complicated by upper gastrointestinal bleeding 1 these ulcers can be caused by shock sepsis trauma or other conditions and are found in patients with chronic illnesses these ulcers are a significant issue in patients in critical and intensive care a distinction between peptic and stress ulcers is their location in the upper gastrointestinal tract whereas ordinary peptic ulcers are found commonly in the gastric antrum and the duodenum stress ulcers are usually found in the fundic mucosa and can be located anywhere within the stomach and proximal duodenum stress ulcers tend to present with multiple lesions whereas in peptic ulcers this is much more uncommon signs and symptoms edit stress ulcers as defined by overt bleeding and hemodynamic instability decreased hemoglobin and or need for transfusion were seen in 1 5 of patients in the 2252 patients in the canadian critical care trials group study 2 people with stress ulcers have a longer icu length of stay up to eight days and a higher mortality up to four fold than patients who do not have stress ulceration and bleeding 3 while the bleeding and transfusions associated with the stress ulcerations contribute to the increased mortality the contribution of factors like low blood pressure sepsis and respiratory failure to the mortality independently of the stress ulceration cannot be ignored citation needed risk factors edit risk factors for stress ulcer formation that have been identified are numerous and varied however two landmark studies and one position paper exist that addresses the topic of risk factors for stress ulcer formation non critically ill medical patients with two or more of the following respiratory failure sepsis heart failure hepatic encephalopathy jaundice kidney failure stroke hypertension previous gastrointestinal disease and treatment with corticosteroids nsaids heparin or warfarin in surgical critically ill patients only those patients who are on a mechanical ventilator for more than 48 hours and or those with a coagulopathy 2 the american society of health system pharmacists guideline recommends against the practice of stress ulcer prophylaxis in non critically ill patients mechanisms edit location edit the ulcerations may be superficial and confined to the mucosa in which case they are more appropriately called erosions or they may penetrate deeper into the submucosa the former may cause diffuse mucosal oozing of blood whereas the latter may erode into a submucosal vessel and produce frank hemorrhage 4 lesions edit the characteristic lesions may be multiple superficial mucosal erosions similar to erosive gastroduodenitis occasionally there may be a large acute ulcer in the duodenum curling s ulcer 5 generally there are multiple lesions located mainly in the stomach and occasionally in the duodenum they range in depth from mere shedding of the superficial epithelium erosion to deeper lesions that involve the entire mucosal thickness ulceration 6 formation edit the pathogenic mechanisms are similar to those of erosive gastritis 6 the pathogenesis of stress ulcer is unclear but probably is related to a reduction in mucosal blood flow or a breakdown in other normal mucosal defense mechanisms in conjunction with the injurious effects of acid and pepsin on the gastroduodenal mucosa 7 diagnosis edit stress ulcer is suspected when there is upper gastrointestinal bleeding in the appropriate clinical setting for example when there is upper gastrointestinal bleeding in elderly patients in a surgical intensive care unit icu with heart and lung disease or when there is upper gastrointestinal bleeding in patients in a medical icu who require respirators citation needed stress ulcer can be diagnosed after the initial management of gastrointestinal bleeding the diagnosis can be confirmed by upper gi endoscopy citation needed prevention edit 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 8 it is unclear which agent is best or if prevention is needed at all 9 benefit may only occur in those who are not being fed 10 possible agents include antacids h2 receptor blockers sucralfate and proton pump inhibitors ppis tentative evidence supports that ppis may be better than h2 blockers 11 concerns with the use of stress ulcer prophylaxis agents include increased rates of pneumonia and clostridioides difficile colitis 10 treatment edit the principles of management are the same as for the chronic ulcer 12 the steps of management are similar as in erosive gastritis 5 endoscopic means of treating stress ulceration may be ineffective and operation required 12 it is believed that shunting blood away from the mucosa makes the mucous membrane ischaemic and more susceptible to injury 5 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 13 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 14 epidemiology edit among those in the intensive care unit ulceration resulting in bleeding is very rare 10 references edit winehouse gerald uptodate www uptodate com uptodate retrieved 3 december 2025 1 2 cook dj fuller hd guyatt gh et al 1994 risk factors for gastrointestinal bleeding in critically ill patients n engl j med 330 6 377 81 doi 10 1056 nejm199402103300601 pmid 8284001 s2cid 76019212 cook dj griffith le et al dec 2001 the attributable mortality and length of intensive care unit stay of clinically important gastrointestinal bleeding in critically ill patients critical care 5 6 368 75 doi 10 1186 cc1071 pmc 83859 pmid 11737927 manual of gastroenterology by gregory l eastwood m d canan avunduk m d ph d 1994 1 2 3 hai a a shrivastava r b 2003 textbook of surgery tata mcgraw hill isbn 0074621491 p 409 1 2 robbins pathological basis of disease 6th edition isbn 8178670526 p 796 manual of gastroenterology gregory l eastwood m d canan avunduk m d ph d 1994 krag m perner a wetterslev j wise mp hylander møller m jan 2014 stress ulcer prophylaxis versus placebo or no prophylaxis in critically ill patients a systematic review of randomised clinical trials with meta analysis and trial sequential analysis intensive care medicine 40 1 11 22 doi 10 1007 s00134 013 3125 3 pmid 24141808 s2cid 24990932 krag m perner a wetterslev j møller mh aug 2013 stress ulcer prophylaxis in the intensive care unit is it indicated a topical systematic review acta anaesthesiologica scandinavica 57 7 835 47 doi 10 1111 aas 12099 pmid 23495933 s2cid 36997236 1 2 3 marik pe vasu t hirani a pachinburavan m nov 2010 stress ulcer prophylaxis in the new millennium a systematic review and meta analysis critical care medicine 38 11 2222 8 doi 10 1097 ccm 0b013e3181f17adf pmid 20711074 s2cid 17819100 alhazzani w alenezi f jaeschke rz moayyedi p cook dj mar 2013 proton pump inhibitors versus histamine 2 receptor antagonists for stress ulcer prophylaxis in critically ill patients a systematic review and meta analysis critical care medicine 41 3 693 705 doi 10 1097 ccm 0b013e3182758734 pmid 23318494 s2cid 8138473 1 2 bailey love s short practice of surgery 23rd edition isbn 0 340 75949 6 page 916 manual of gastroenterology priyank sinha gregory l eastwood m d canan avunduk m d ph d 1994 a practical approach to emergency medicine by robert j stine m d carl r chudnofsky m d cynthia k aaron m d 1994 v t e intensive care medicine health science medicine medical specialities respiratory therapy general terms intensive care unit icu neonatal intensive care unit nicu pediatric intensive care unit picu coronary care unit ccu critical illness insurance geriatric intensive care unit conditions organ system failure shock sequence sirs sepsis severe sepsis septic shock multiple organ dysfunction syndrome other shock cardiogenic shock distributive shock anaphylaxis obstructive shock neurogenic shock spinal shock vasodilatory shock organ failure acute renal failure acute respiratory distress syndrome acute liver failure respiratory failure multiple organ dysfunction syndrome neonatal infection polytrauma coma complications critical illness polyneuropathy myopathy critical illness related corticosteroid insufficiency decubitus ulcers fungemia stress hyperglycemia stress ulcer iatrogenesis methicillin resistant staphylococcus aureus oxygen toxicity refeeding syndrome ventilator associated lung injury ventilator associated pneumonia dialytrauma diagnosis arterial blood gas catheter arterial line central venous catheter pulmonary artery catheter blood cultures screening cultures life supporting treatments airway management and mechanical ventilation tracheal intubation cardiac devices intra aortic balloon pump ventricular assist device chest tube kidney dialysis early goal directed therapy induced coma nutritional supplementation enteral feeding total parenteral nutrition therapeutic hypothermia drugs analgesics antibiotics antithrombotics inotropes intravenous fluids neuromuscular blocking drugs recombinant activated protein c sedatives stress ulcer prevention drugs vasopressors icu scoring systems apache ii glasgow coma scale pim2 saps ii saps iii sofa physiology hemodynamics hypotension level of consciousness acid base imbalance water electrolyte imbalance organisations society of critical care medicine surviving sepsis campaign european society of paediatric and neonatal intensive care related specialties anesthesiology internal medicine cardiology neurology pulmonology pediatrics surgery traumatology retrieved from https en wikipedia org w index php title stress_ulcer oldid 1325550169 prevention categories intensive care medicine gastrointestinal tract disorders hidden categories articles with short description short description is different from wikidata short description matches wikidata all articles with unsourced statements articles with unsourced statements from august 2020 this page was last edited on 3 december 2025 at 18 39 utc page was rendered with parsoid text is available under the creative commons attribution sharealike 4 0 license additional terms may apply by using this site you agree to the terms of use and privacy policy wikipedia is a registered trademark of the wikimedia foundation inc a non profit organization privacy policy about wikipedia disclaimers contact wikipedia legal safety contacts code of conduct developers statistics cookie statement mobile view search search toggle the table of contents stress ulcer 3 languages add topic