Authors: Aaron Woofter, MD; Richard Goodgame, MD Series Editor: Richard Goodgame, MD

Disclosures

August 22, 2006

Discussion

Despite more than 20 years of careful study, numerous analyses, meta-analyses, and algorithms, the frequency, significance, and prevention of stress-related gastrointestinal bleeding remains mired in controversy. Comprehensive summaries of the data and issues are available.[4,5,20,28,37] Published algorithms can be used to standardize therapy.[13] As discussed previously, some experts suggest that current recommendations for H2RAs and sucralfate do not prevent the low frequency of clinically significant bleeding. Others suggest that even in the absence of clinical trials, more potent (and more costly) PPIs should be substituted for the less effective drugs so that events such as the one seen in our patient, do not occur. Unfortunately, most prophylactic regimens are used for too long and are maintained after the high-risk period.[40,41] Inappropriate use of PPIs in hospitalized patients is common and costly.[42,43,44]

The patient that we presented here demonstrates a classic case of stress-related gastric mucosal disease; it further represents a classic case of incomplete knowledge and incomplete application of knowledge in medicine.

Comments

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