GI stress ulcer in ICU

Q: Which of the gastrointestinal (GI) stress ulcers tend to bleed more in the ICU? (select one)

A) developed early on ICU admission

B) developed late in ICU course

Answer: B

The most common site for GI stress ulcerations in ICU is the fundus and body of the stomach, though they can develop in the antrum, duodenum, or distal esophagus. Most of the GI stress ulcerations developed in the ICU are shallow and may ooze from the superficial capillary beds. Though under-appreciated, ulcerations develop within hours of major trauma or severe sickness. Early ulcerations are usually gastric.

Stress ulcerations that develop late after a few days of ICU admission tend to be deeper and intestinal in the antrum and duodenum.

Various mechanisms lead to these ulcerations. Hypovolemia, shock, sepsis, or trauma leads to poor gut perfusion. There may be an excessive gastrin stimulation of parietal cells in patients with head trauma. Also, there may be an increased concentration of refluxed bile salts or uremic toxins, which may disturb the barrier of the glycoprotein mucous layer in the stomach.

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References:

1. Stollman N, Metz DC. Pathophysiology and prophylaxis of stress ulcer in intensive care unit patients. J Crit Care. 2005 Mar;20(1):35-45. doi: 10.1016/j.jcrc.2004.10.003. PMID: 16015515.

2. Buendgens L, Koch A, Tacke F. Prevention of stress-related ulcer bleeding at the intensive care unit: Risks and benefits of stress ulcer prophylaxis. World J Crit Care Med. 2016 Feb 4;5(1):57-64. doi: 10.5492/wjccm.v5.i1.57. PMID: 26855894; PMCID: PMC4733456.

3. Reynolds PM, MacLaren R. Re-evaluating the Utility of Stress Ulcer Prophylaxis in the Critically Ill Patient: A Clinical Scenario-Based Meta-Analysis. Pharmacotherapy. 2019 Mar;39(3):408-420. doi: 10.1002/phar.2172. Epub 2018 Sep 6. PMID: 30101529.