Dr. Prittie is an Assistant Editor for the journal but did not have any input in the peer review process of this manuscript other than as an author. The authors declare no other conflicts of interest.
Clinical Practice Review
A review of stress-related mucosal disease
Article first published online: 10 OCT 2011
© Veterinary Emergency and Critical Care Society 2011
Journal of Veterinary Emergency and Critical Care
Volume 21, Issue 5, pages 484–495, October 2011
How to Cite
Monnig, A. A. and Prittie, J. E. (2011), A review of stress-related mucosal disease. Journal of Veterinary Emergency and Critical Care, 21: 484–495. doi: 10.1111/j.1476-4431.2011.00680.x
- Issue published online: 10 OCT 2011
- Article first published online: 10 OCT 2011
- Manuscript Accepted: 11 AUG 2011
- Manuscript Received: 31 OCT 2010
- gastric mucosal defense;
- histamine2-receptor antagonist;
- proton pump inhibitor;
- stress-related mucosal disease;
- stress ulcer prophylaxis;
To review and summarize the human and veterinary literature regarding stress-related mucosal disease (SRMD) pathogenesis, patient risk factors, and therapeutic options for prophylaxis and treatment.
SRMD is a common sequela of critical illness in human patients. Development of SRMD results from splanchnic hypoperfusion, reperfusion injury, and exposure of the gastric mucosa to acid, pepsin, and bile acids following breakdown of the gastric mucosal defense system. Human patients with the highest risk of stress ulceration include those with respiratory failure necessitating mechanical ventilation greater than 48 h or coagulopathy. Currently, little is known about the incidence and pathophysiology of SRMD in critically ill veterinary patients.
A presumptive diagnosis can be made in high-risk patient populations following detection of occult or gross blood in nasogastric tube aspirates, hematemesis, or melena. Definitive diagnosis is achieved via esophagogastroduodenoscopy. Lesions are localized to the acid-producing portions of the stomach, the fundus, and body.
Therapy is aimed at optimization of tissue perfusion and oxygenation. Pharmacologic interventions are instituted to increase intraluminal pH and augment natural gastric defenses. Histamine2-receptor antagonists, proton pump inhibitors, and sucralfate are the mainstays of therapy. In people, clinically significant bleeding may necessitate additional interventions (eg, packed red blood cell transfusions, endoscopic, or surgical hemostasis).
Mortality is increased in people with clinically significant bleeding compared to those patients who do not bleed. Institution of prophylaxis is recommended in high-risk patients. However, no consensus exists regarding initiation of prophylaxis, preference of frontline drug class, or indication for discontinuation of therapy. The prognosis of veterinary patients with SRMD remains unknown at this time.