Skip to main content
main-content

Tipp

Weitere Artikel dieser Ausgabe durch Wischen aufrufen

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

Einloggen, um Zugang zu erhalten
share
TEILEN

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.

Sie möchten Zugang zu diesem Inhalt erhalten? Dann informieren Sie sich jetzt über unsere Produkte:

Abo für kostenpflichtige Inhalte

Literatur
1.
Zurück zum Zitat 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 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
2.
Zurück zum Zitat 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. 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.
3.
Zurück zum Zitat 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 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
4.
Zurück zum Zitat 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 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
5.
Zurück zum Zitat 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 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
6.
Zurück zum Zitat 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 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
7.
Zurück zum Zitat 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 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
8.
Zurück zum Zitat 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 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
9.
Zurück zum Zitat 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 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.
Zurück zum Zitat 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 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
12.
Zurück zum Zitat Lam NP, Le P-DT, Crawford SY, Patel S. National survey of stress ulcer prophylaxis. Crit Care Med. 1999;27:98–103. PubMedCrossRef Lam NP, Le P-DT, Crawford SY, Patel S. National survey of stress ulcer prophylaxis. Crit Care Med. 1999;27:98–103. PubMedCrossRef
13.
Zurück zum Zitat 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 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.
Zurück zum Zitat 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. 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.
Zurück zum Zitat 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 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.
Zurück zum Zitat 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. 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.
Zurück zum Zitat 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 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.
Zurück zum Zitat 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. 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.
Zurück zum Zitat 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 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.
Zurück zum Zitat 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. 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.
Zurück zum Zitat 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 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.
Zurück zum Zitat 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. 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.
Zurück zum Zitat Balaban DH, Duckworth CW, Peura DA. Nasogastric omeprazol. Effect on gastric pH in critically ill patients. Am J Gastroenterol. 1997;92:79–83. PubMed 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.
Zurück zum Zitat 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 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.
Zurück zum Zitat 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 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.
Zurück zum Zitat 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 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.
Zurück zum Zitat 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 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.
Zurück zum Zitat Lam NP, Le P-TD, Crawford SY, Patel S. National survey of stress ulcer prophylaxis. Crit Care Med. 1999;27:98–103. PubMedCrossRef Lam NP, Le P-TD, Crawford SY, Patel S. National survey of stress ulcer prophylaxis. Crit Care Med. 1999;27:98–103. PubMedCrossRef
29.
Zurück zum Zitat 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 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.
Zurück zum Zitat Hsu TC, Leu SC, Hu CF, Huang PC, Tsai LF. Assessment of intragastric pH after early nasogastric feeding. Nutrition. 2000;16:751–4. PubMedCrossRef 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.
Zurück zum Zitat Roberts DE, Hall KW, Dobson KE, Light RB. Effects of prolonged naloxone infusion in septic shock. Lancet. 1988;ii:699–702. Roberts DE, Hall KW, Dobson KE, Light RB. Effects of prolonged naloxone infusion in septic shock. Lancet. 1988;ii:699–702.
32.
Zurück zum Zitat 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 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.
Zurück zum Zitat 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 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.
Zurück zum Zitat 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 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.
Zurück zum Zitat Forssell H, Stenquist B, Olbe L. Vagal stimulation of human gastric bicarbonate secretion. Gastroenterology. 1985;89:581–6. PubMed Forssell H, Stenquist B, Olbe L. Vagal stimulation of human gastric bicarbonate secretion. Gastroenterology. 1985;89:581–6. PubMed
36.
Zurück zum Zitat 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 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
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