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Erschienen in: Wiener klinische Wochenschrift 1-2/2015

01.01.2015 | original article

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

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

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
Nächster Artikel Injury pattern in correlation with the height of fatal falls
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Metadaten
Titel
Effect of proton pump inhibitors on gastric pH in patients exposed to severe stress
verfasst von
Prof. Dr. Kurt Lenz
MD Robert Buder
MD Fritz Firlinger
MD Gerald Lohr
MD Martin Voglmayr
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

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