Stress Ulcer Prophylaxis

Stress Ulcer General Information

Stress Ulcer is a mucosal defect or open sores that form on the inside of the esophagus or of the stomach. These may be complicated by bleeding in the upper gastrointestinal tract during periods of illness due to psychological stress. Typically, these defects and sores can be found anywhere in the stomach or in the proximal duodenum, in the fundic mucosa, whereas regular peptic ulcers may appear in the duodenum and in the gastric antrum.

There are several various risk factors which may contribute to the appearance of Stress Ulcer. Among these, history of gastrointestinal affections, prolonged treatment with Warfarin, heparin, NSAIDS or corticosteroids are conditions which often cause the appearance of such sores. Other medical conditions which may lead to the appearance of gastric mucosa defects are respiratory failure, heart failure, sepsis, hepatic encephalopathy, renal failure, jaundice, hypotension or stroke. Patients suffering from coagulopathy and patients that are mechanically ventilated are also exposed to a higher risk of developing this affection. There are several other risk factors that may lead to the appearance of this medical condition, but in almost all situations, psychological stress is a contributing factor to the development of the disease and may aggravate the ulcer symptoms. For more information regarding the risk factors, it is advised to consult a specialized health care professional.

Stress Ulcer Prophylaxis

Stress Ulcer Prophylaxis is a far better alternative to treating the affection once it sets in. Most commonly, the means employed in order to prevent this affection include antacids, Sucralfate, H2-receptor blockers, Proton pump inhibitors, Prostaglandin analogue agents and of course, nutrition is one of the most basic means to control the elements which may contribute directly to the appearance of sores in the gastrointestinal tract.

Stress Ulcer Prophylaxis related studies have shown that antacids are a very effective means of preventing this affection, along with H2-receptor blockers – however research has shown that the results are roughly the same when compared to those obtained after a placebo based preventive study. As a result, antacids are less used in the prevention of this affection, although the H2-receptor blockers are very commonly one of the preferred means used in an attempt to prevent the formation of sores. These have been repeatedly proven as effective during scientific trials; however in some cases the results were not as satisfactory as expected.

Sucralfate, another agent commonly employed as part of Stress Ulcer Prophylaxis, does not have the same effectiveness as the above two agents. As research has shown, Sucralfate has a lower effectiveness than Ranitidine (a drug from the H2-receptor blockers class of medication); however it may be employed in cases where administration of other preventive agents is inappropriate. Proton pump inhibitors are another type of agents that are widely used as part of Stress Ulcer Prophylaxis. While some studies have shown them to be very effective in preventing bleeding episodes and no signs of toxicity have been found in the patients undergoing preventive treatment, extensive research has yet to be performed.

The patient’s diet may require adjustment in order to prevent this affection and / or to reduce the severity of the symptoms. Acidic and spicy foods should be avoided, as they increase gastric acidity and aggravate the pain. Smoking may cause the stomach to become more susceptible to ulcers, and alcohol consumption can irritate the mucous lining of the gastrointestinal tract, resulting in a higher risk of inflammation and hemorrhage. Certain medication types, such as non-steroidal anti-inflammatory drugs also pose a greater threat to the mucous lining of the stomach and may increase the risk of developing sores, and thus they should be avoided. Generally, any factor which may increase gastric acidity should be considered as part of the prophylactic program in healthy individuals as well as in those which have a higher risk of developing gastrointestinal affections of this type.

Stress Ulcer Treatment

Apart from the prophylactic use of medication, the same drugs may be employed in the treatment of Stress Ulcer. As such, a patient affected by this condition may start a treatment with Proton pump inhibitors, H2-blockers and mucosal protective agents, or a combination of these with antibiotics if bacterial infections are also present. In cases where the affection fails to heal with medication therapy, surgery may be required. H2-blockers such as Ranitidine, Famotidine, Cimetidine or Nizatidine help reduce the gastric acid production, allowing the sores to heal. Taken as a single daily dose before bedtime, H2-blockers typically lead to healing within four to eight weeks.

Proton pump inhibitors act by inhibiting the last step of gastric acid secretion. Studies have shown a recent drug from this class, Omeprazole, to suppress up to 95% of the production of gastric acid, and speeding the healing process to just two to four weeks. This is a highly recommended treatment for patients with ulcers that are resistant to normal H2-blocker treatment. Antibiotics are typically used in cases of Stress Ulcer which also involve infections with H. pylori bacteria.

In cases where the affection does not respond to medication treatment, surgery may be employed. Three types of operations may be performed in order to restore the patient’s health: vagotomy, pyloroplasty and antrectomy.