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Erosive Gastritis
Aka: Erosive Gastritis, Hemorrhagic Gastritis, Multiple Gastric Erosions, Stress Ulcer, Gastrointestinal Prophylaxis, Prophylaxis Against Gastrointestinal Ulcer, Gastric Ulcer Prophylaxis, Gastric Ulcer Prevention in Patients with Critically Illness
- See Also
- Dyspepsia
- Peptic Ulcer Disease
- Causes
- See Peptic Ulcer Disease
- Medications
- Aspirin
- NSAIDs
- Alcohol
- Severe stress (mucosal protection breaks down, allows for splanchnic hypoperfusion)
- Burns
- Sepsis
- Trauma
- Surgery
- Shock
- Respiratory Failure
- Renal Failure
- Liver failure
- Mechanical Ventilation
- Symptoms (May be asymptomatic)
- Epigastric discomfort
- Nausea or Vomiting
- Hematemesis
- Melena
- Signs
- See Peptic Ulcer Disease
- Epigastric tenderness
- Diagnosis
- Upper endoscopy (EGD)
- Mucosal inflammation and engorgement
- Erosions and Hemorrhages
- Upper GI barium study
- Thickened rugae
- Management
- See Acute Gastrointestinal Bleeding Management
- See Peptic Ulcer Disease
- ABC Management first
- Prevention: Critically ill hospitalized patients (ICU)
- Indications: High risk patients in ICU
- Mechanical Ventilation
- Coagulopathy
- Multiple Traumatic injuries
- Recent Gastrointestinal Bleeding
- High dose Corticosteroids (equivalent to Prednisone 60 mg/day)
- Protocol
- Start GI prophylaxis in high risk ICU patients
- Risk of stress-ulcer related GI Bleeding in the ICU: 25%
- Discontinue prophylaxis on transfer out of Intensive Care unit
- Risk of Stress Ulcer related GI Bleeding drops to <1% outside the ICU
- General Measures
- Avoid NSAIDS in ICU patients
- Stop Aspirin in primary prevention (no known Coronary Artery Disease)
- Initiate early Enteral Nutrition
- Option 1: Maintain gastric pH > 4
- Proton Pump Inhibitor (PPI)
- Preparations
- Omeprazole (Prilosec) 20-40 mg orally daily
- Pantoprazole (Protonix) 40 mg IV daily
- Adverse effects
- Risk of Nosocomial Pneumonia (Protect against Aspiration Pneumonia)
- Risk of Clostridium difficile
- Efficacy
- May be more effective than H2 Blockers in ICU Stress Ulcer related GI Bleeding (variable evidence)
- Alhazzani (2013) Crit Care Med 41(3): 693-705 [PubMed]
- H2 Antagonist IV infusion
- Preparations
- Famotidine 20 mg IV every 12 hours
- Ranitidine 50 mg IV every 8 hours
- Avoid Cimetidine due to Drug Interactions
- Modify dose when GFR <50ml/min
- Efficacy
- May be preferred over PPI with fewer adverse effects
- Some studies suggest similar efficacy in prevention of GI Bleeding
- (2014) Presc Lett 21(4): 24
- MacLaren (2014) Crit Care Med 42(4): 809-15 [PubMed]
- Option 2: Topical protectants
- Sucralfate (carafate) slurry 1 g PO q6h
- Misoprostol 200 ug PO qid
- Less risk of Aspiration Pneumonia than Option 1
- References
- Marino (2014) ICU Book, p. 77-88
- Internet Book of Critical Care (Farkas, EM-Crit)
- https://emcrit.org/ibcc/guide/