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

Zeitschrift:: Wiener klinische Wochenschrift > Ausgabe 1-2/2015

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

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.

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

Springer Medizin Österreich

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Summary

Background

Objectives

Methods

Mean outcome measure

Results

Conclusion

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