Abstract
Gastrointestinal bleeding from stress-related mucosal damage (SRMD) is caused by a breakdown in the pro cesses that normally protect the gastric mucosa from the corrosive effects of gastric acid and the proteolytic enzyme pepsin. Prostaglandins stimulate some of these protective factors, which include mucus secretion, bi carbonate secretion, rapid cellular repair and rapid blood flow. Acid and pepsin inhibit blood clotting in the stomach by inhibiting platelet aggregation and the func tion of all of the blood clotting factors. The inhibition of blood clotting in the stomach exacerbates bleeding caused by ulcers in the stomach and duodenum. Hence, treatment that will raise intragastric pH (lower acid con centration) should be effective in preventing gastric bleeding from SRMD. Patients in intensive care units are at high risk of developing upper gastrointestinal bleed ing from SRMD. It is easier to prevent SRMD bleeding than to treat it once it starts. Hence, patients in intensive care units should be treated prophylactically to prevent bleeding. Controlled trials and clinical experience indi cate that both antacids and H2 blockers in doses high enough to raise the intragastric pH above 4 are effective forms of prophylaxis. Intravenously administered H2 blockers are more convenient to administer and have fewer side effects than the large doses of antacid re quired to maintain the intragastric pH above 4.
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