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Hemorrhagic gastritis, multiple gastric erosions may be caused by aspirin and other NSAIDs (lower risk with newer agents, e.g., nabumetone and etodolac, which do not inhibit gastric mucosal prostaglandins) or severe stress (burns, sepsis, trauma, surgery, shock, or respiratory, renal, or liver failure). Pt may be asymptomatic or experience epigastric discomfort, nausea, hematemesis, or melena. Diagnosis is made by upper endoscopy.

Treatment: Erosive Gastropathies

Removal of offending agent and maintenance of O2 and blood volume as required. For prevention of stress ulcers in critically ill pts, hourly oral administration of liquid antacids (e.g., Maalox 30 mL), IV H2 receptor antagonist (e.g., cimetidine, 300-mg bolus + 37.5-50 mg/h IV), or both is recommended to maintain gastric pH > 4. Alternatively, sucralfate slurry, 1 g PO q6h, can be given; does not raise gastric pH and may thus avoid increased risk of aspiration pneumonia associated with liquid antacids. Pantoprazole can be administered IV to suppress gastric acid in the critically ill. Misoprostol, 200 µg PO qid, or profound acid suppression (e.g., famotidine, 40 mg PO bid) can be used with NSAIDs to prevent NSAID-induced ulcers.

Outline

Section 11. Gastroenterology