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Effect of proton pump inhibitors on gastric pH in patients exposed to severe stress

verfasst von: Prof. Dr. Kurt Lenz, Robert Buder, MD, Fritz Firlinger, MD, Gerald Lohr, MD, Martin Voglmayr, MD

Erschienen in: Wiener klinische Wochenschrift | Ausgabe 1-2/2015

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Summary

Background

The incidence of upper gastrointestinal bleeding from stress ulcers has decreased within the last 30 years. Improvements in intensive care medicine including advanced equipment for artificial ventilation, better sedoanalgesic therapies, and the use of stress ulcer prophylaxis are credited for the decline.

Objectives

To determine the effectiveness of proton pump inhibitors (PPIs) on gastric pH in patients exposed to a defined severe stress situation during a specified time period.

Methods

Prospective open study in a tertiary community hospital. A high dose (80 mg bolus followed by 8 mg/h) of either pantoprazol or omeprazol was infused in 17 patients with opiate dependence who were undergoing ultra-rapid opiate withdrawal by barbiturate anesthesia.

Mean outcome measure

Gastric pH.

Results

Gastric pH did not change significantly in the majority of patients (mean pH 1.2 ± 0.9 immediately before, 1.5 ± 1.6 at 60 min after, and 1.3 ± 1.5 at 120 min after PPI infusion began). Gastric pH increased temporarily in two of the nine patients receiving omeprazol. In two of the eight patients, pantoprazol led to a late but sustained increase in gastric pH (pH 3.9 and 6.0 at 120 min post infusion).

Conclusion

High doses of PPIs are ineffective in elevating gastric pH in patients exposed to severe stress such as ultra-rapid opiate detoxification. Therefore, adequate sedoanalgesia might be the main factor responsible for preventing stress-related bleeding in critically ill patients.

Vorheriger Artikel The major predictors of amputation and length of stay in diabetic patients with acute foot ulceration

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Cook DJ, Fuller HD, Guyatt GH, Marshall JC, Leasa D, Hall R, Winton TL, Rutledge F, Todd Th, Roy P, Lacroix J, Griffith L, Willan A, for the Canadian Critical Care Trials Group. Risk factors for gastrointestinal bleeding in critically ill patients. N Engl J Med. 1994;330:377–81. PubMedCrossRef

Zinner MJ, Zuidena GD, Smih PL, Mignosa M. The prevention of gastrointestinal bleeding in patients in an intensive care unit. Gynecol Obstet. 1981;153:214–20.

Fennerty MB. Pathophysiology of the upper gastrointestinal tract in the critically ill patient: rationale for the therapeutic benefits of acid suppression. Crit Care Med. 2002;30(Suppl):S351–5. PubMedCrossRef

Fiddian-Green RG, McGough E, Pittenger G, Rothman E. Predictive value of intramural pH and other risk factors for massive bleeding form stress ulceration Gastroenterology. 1983;85:613–20. PubMed

Cook D, Reeve BK, Gyatt GH, et al. Stress ulcer prophylaxis in critically ill patients. Resolving discordant meta-analysis. JAMA. 1996;275:308–14. PubMedCrossRef

Simms HH, deMaria E, McDonald L, Peterson D, Robinson A, Burchard KW. Role of gastric colonization in the development of pneumonia in critically ill trauma patients: a result of a prospective randomized trial. J Trauma. 1991;31:531–6. PubMedCrossRef

Laheij RJF, Sturkenboom MCJM, Hassing R-J, et al. Risk of community-acquired pneumonia and use of gastric acid-suppressive drugs. JAMA. 2004;292:1955–60. PubMedCrossRef

Torpey N, Barker T, Ross C. Drug-induced tubulo-interstitial nephritis secondary to proton pump inhibitors: experience from a single UK renal unit. Nephrol Dial Transplant. 2004;19:1441–6. PubMedCrossRef

Heidelbaugh JJ, Kim AH, Chang R, Walker PC. Overutilization of proton pump inhibitors: what clinician needs to know. Ther Adv Gastroenterol. 2012;5:219–32. CrossRef

10.

Marik PE, Vasu T, Hirnai A, Pachinburavan M. Stress ulcer prophylaxis in the new millennium: a systematic review and meta-analysis. Crit Care Med. 2010;38:2222–8. PubMedCrossRef

11.

Chanpura T, Yende S. Weighing risks and benefits of stress ulcer prophylaxis in critically ill patients. Crit Care. 2012;16:322. PubMedCentralPubMedCrossRef

12.

Lam NP, Le P-DT, Crawford SY, Patel S. National survey of stress ulcer prophylaxis. Crit Care Med. 1999;27:98–103. PubMedCrossRef

13.

Netzer P, Gaia C, Sandoz M, Huluk T, Gut A, Halter F, Husler J, Inauen W. Effect of repeated injection and continuous infusion of omeprazol and ranitidine on intragastric pH over 72 hours. Am J Gastroenterol. 1999;94:351–7. PubMed

14.

Loimer N, Schmid RW, Presslich O, Lenz K. Continuous naloxone administration suppresses opiate withdrawal symptoms in human opiate addicts during detoxification treatment. J Psychiat Res. 1989;23:81–6.

15.

Kiefer P, Nunes S, Kosonen P, Takal J. Effect of positive end-expiratory pressure on splanchnic perfusion in acute lung injury. Intensive Care Med. 2000;26:376–83. PubMedCrossRef

16.

Guth PH, Smith E. Nervous regulation of the gastric microcirculation. In: Brooks FP, Evers PW, editors. Nerves and the gut. New York: CB Slack; 1977. pp. 365–73.

17.

Zandstra DF, Stootenbeck ChP. The virtual absence of stress-ulceration related bleeding in ICU patients receiving prolonged mechanical ventilation without prophylaxis. Intensive Care Med. 1994;20:335–40. PubMedCrossRef

18.

Reilly J, Fennert MB. Stress ulcer prophylaxis: the prevention of gastrointestinal bleeding and the development of nosocomial infection in critically ill patients. J Pharmacol Prac. 1998;11:418–32.

19.

Maury E, Tankovic J, Ebel A, Offenstadt G. An observational study of upper gastrointestinal bleeding in intensive care units: is Helicobacter pylori the culprit? Crit Care Med. 2005;33:1513–8. PubMedCrossRef

20.

Sollboehmer M, Tillenburg B, Börsch G. Gastric pH profiles in patients with peptic ulcer bleeding treated with continuous infusions of omeprazol or ranitidine. Gastroenterology. 1994;106:A114.

21.

Lew EA, Pisegna JR, Starr JA, Soffer EF, Forsmark C, Modlin IM, Walsh JH, Beg M, Bochenek W, Metz DC. Intravenous pantoprazol rapidly controls gastric acid hypersecretion in patients with Zollinger-Ellison syndrome. Gastroenterology. 2000;118:696–700. PubMedCrossRef

22.

Nether P, Gaka C, Sandoz M, Huluk T, Gut A, Halter F, Husler J, Inauen W. Effect of repeated injection and continuous infusion of omeprazol and ranitidine on intragastric pH over 72 hours. Am J Gastroenterol. 1999;94:351–7.

23.

Balaban DH, Duckworth CW, Peura DA. Nasogastric omeprazol. Effect on gastric pH in critically ill patients. Am J Gastroenterol. 1997;92:79–83. PubMed

24.

Cook D, Gyatt G, Marshall J, et al. A comparison of sucralfat and ranitidine for the prevention of upper gastrointestinal bleeding in patients requiring mechanical ventilation. N Engl J Med. 1998;338:791–7. PubMedCrossRef

25.

Krag M, Perner A, Wetterslev J, Wise MP, Moller MH. Stress ulcer prophylaxis versus placebo or no prophylaxis in critically ill patients. Intensive Care Med. 2014;40:11–22. PubMedCrossRef

26.

Kienbaum P, Scherbaum N, Thürauf N, Michel CM, Gastpar M, Peters J. Acute detoxification of opioid addicted patients with naloxone during propofol or methohexital anesthesia: a comparison of withdrawal symptoms, neuroendocrine, metabolic, and cardiovascular patterns. Crit Care Med. 2000;28:969–76. PubMedCrossRef

27.

Lau JY, Sung JJ, Lee KK, Yung MK, Wong SK, Wu JC, Chan FK, Enders KW, You JH, Lee CW, Chan AC, Chung SC. Effect of intravenous omeprazol on recurrent bleeding after endoscopic treatment of bleeding peptic ulcers. N Engl J Med. 2000;343:310–6. PubMedCrossRef

28.

Lam NP, Le P-TD, Crawford SY, Patel S. National survey of stress ulcer prophylaxis. Crit Care Med. 1999;27:98–103. PubMedCrossRef

29.

Lasky MR, Metzler MH, Philips JO. A prospective study of omeprazole suspension to prevent clinically significant gastrointestinal bleeding from stress ulcers in mechanically ventilated trauma patients. J Trauma. 1998;44:527–33. PubMedCrossRef

30.

Hsu TC, Leu SC, Hu CF, Huang PC, Tsai LF. Assessment of intragastric pH after early nasogastric feeding. Nutrition. 2000;16:751–4. PubMedCrossRef

31.

Roberts DE, Hall KW, Dobson KE, Light RB. Effects of prolonged naloxone infusion in septic shock. Lancet. 1988;ii:699–702.

32.

Feldman M, Walsh JH, Taylor IL. Effect of naloxone and morphine on gastric acid secretion and on serum gastrin and pancreatic polypeptide concentration in humans. Gastroenterology. 1980;79:294–6. PubMed

33.

Rees WDW, Gibbons LC, Turnberg LA. Influence of opiates on alkali secretion by amphibian gastric and duodenal mucosa in vitro. Gastroenterology. 1986;90:323–7. PubMed

34.

Jacob SM, Parviainen I, Ruokonen E, Uusaro A, Takala J. Lack of effect of ranitidine on gastric luminal pH and mucosal pC02 during the first day in the ICU. Acta Anesthesiol Scand. 2005;49:390–6. CrossRef

35.

Forssell H, Stenquist B, Olbe L. Vagal stimulation of human gastric bicarbonate secretion. Gastroenterology. 1985;89:581–6. PubMed

36.

Pique JM, Leung FW, Tan HW, Livingston E, Scremin OU, Guth PH. Gastric mucosal blood flow response to stimulation and inhibition of gastric acid secretion. Gastroenterology. 1988;95:642–50. PubMed

Titel: Effect of proton pump inhibitors on gastric pH in patients exposed to severe stress
verfasst von: Prof. Dr. Kurt Lenz
Robert Buder, MD
Fritz Firlinger, MD
Gerald Lohr, MD
Martin Voglmayr, MD
Publikationsdatum: 01.01.2015
Verlag: Springer Vienna
Erschienen in: Wiener klinische Wochenschrift / Ausgabe 1-2/2015
Print ISSN: 0043-5325
Elektronische ISSN: 1613-7671
DOI: https://doi.org/10.1007/s00508-014-0637-y

Springer Medizin Österreich

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Effect of proton pump inhibitors on gastric pH in patients exposed to severe stress

Summary

Background

Objectives

Methods

Mean outcome measure

Results

Conclusion

Springer Medizin Österreich

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Weitere Artikel dieser Ausgabe durch Wischen aufrufen

Summary

Background

Objectives

Methods

Mean outcome measure

Results

Conclusion

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