Use of Enteral Nutrition for Gastrointestinal Bleeding Prophylaxis in the Critically Ill: Review of Current Literature

Overview

Journal Curr Nutr Rep

Specialty Nutritional Sciences

Date 2018 Jul 6

PMID 29974343

Citations 1

Authors

Carolyn Newberry

Jessica Schucht

Affiliations

Soon will be listed here.

Abstract

Purpose Of Review: This review provides a comprehensive overview of the etiology of stress-related mucosal disease, current acid suppression therapy recommendations, and the role enteral nutrition may play in disease prevention.

Recent Findings: Recent literature indicates enteral nutrition may prevent complications of stress-related mucosal disease by increasing splanchnic blood flow, enhancing gastrointestinal motility, and promoting cellular immunity and integrity through local nutrient delivery. Stress-related mucosal disease is a common complication of hospitalization in the critically ill which may lead to overt gastrointestinal bleeding and enhanced mortality. High-risk patients have historically been prescribed acid suppression therapy, though enteral nutrition may also have a role in disease mitigation.

Citing Articles

Intestinal Mucosal Immune Barrier: A Powerful Firewall Against Severe Acute Pancreatitis-Associated Acute Lung Injury via the Gut-Lung Axis.

Li F, Wang Z, Cao Y, Pei B, Luo X, Liu J J Inflamm Res. 2024; 17:2173-2193.

PMID: 38617383 PMC: 11016262. DOI: 10.2147/JIR.S448819.

References

Metz C, Livingston D, Smith J, Larson G, Wilson T . Impact of multiple risk factors and ranitidine prophylaxis on the development of stress-related upper gastrointestinal bleeding: a prospective, multicenter, double-blind, randomized trial. The Ranitidine Head Injury Study Group. Crit Care Med. 1993; 21(12):1844-9. DOI: 10.1097/00003246-199312000-00010. View

Kim J, Sheibani S, Park S, Buxbaum J, Laine L . Causes of bleeding and outcomes in patients hospitalized with upper gastrointestinal bleeding. J Clin Gastroenterol. 2013; 48(2):113-8. DOI: 10.1097/MCG.0b013e318297fb40. View

Pfau P, Cooper G, Carlson M, Chak A, Sivak Jr M, Gonet J . Success and shortcomings of a clinical care pathway in the management of acute nonvariceal upper gastrointestinal bleeding. Am J Gastroenterol. 2004; 99(3):425-31. DOI: 10.1111/j.1572-0241.2004.04090.x. View

Raff T, Germann G, Hartmann B . The value of early enteral nutrition in the prophylaxis of stress ulceration in the severely burned patient. Burns. 1997; 23(4):313-8. DOI: 10.1016/s0305-4179(97)89875-0. View

Kondrup J . Nutritional-risk scoring systems in the intensive care unit. Curr Opin Clin Nutr Metab Care. 2014; 17(2):177-82. DOI: 10.1097/MCO.0000000000000041. View

Martin L, Booth F, Karlstadt R, Silverstein J, Jacobs D, Hampsey J . Continuous intravenous cimetidine decreases stress-related upper gastrointestinal hemorrhage without promoting pneumonia. Crit Care Med. 1993; 21(1):19-30. DOI: 10.1097/00003246-199301000-00009. View

Palm N, McKinzie B, Ferguson P, Chapman E, Dorlon M, Eriksson E . Pharmacologic Stress Gastropathy Prophylaxis May Not Be Necessary in At-Risk Surgical Trauma ICU Patients Tolerating Enteral Nutrition. J Intensive Care Med. 2016; 33(7):424-429. DOI: 10.1177/0885066616678385. View

Ephgrave K, Adair C . Enteral nutrients prevent stress ulceration and increase intragastric volume. Crit Care Med. 1990; 18(6):621-4. DOI: 10.1097/00003246-199006000-00009. View

Barletta J, Kanji S, MacLaren R, Lat I, Erstad B . Pharmacoepidemiology of stress ulcer prophylaxis in the United States and Canada. J Crit Care. 2014; 29(6):955-60. DOI: 10.1016/j.jcrc.2014.06.025. View

10.

Barnes J . Enteral Nutrients and Gastrointestinal Physiology. J Infus Nurs. 2018; 41(1):35-42. DOI: 10.1097/NAN.0000000000000260. View

11.

Saxena B, Singh S . Comparison of three acute stress models for simulating the pathophysiology of stress-related mucosal disease. Drug Discov Ther. 2017; 11(2):98-103. DOI: 10.5582/ddt.2016.01081. View

12.

Armstrong D, Castiglione F, Emde C, Cilluffo T, Duroux P, Koerfer J . The effect of continuous enteral nutrition on gastric acidity in humans. Gastroenterology. 1992; 102(5):1506-15. DOI: 10.1016/0016-5085(92)91708-c. View

13.

Kantorova I, Svoboda P, Scheer P, Doubek J, Rehorkova D, Bosakova H . Stress ulcer prophylaxis in critically ill patients: a randomized controlled trial. Hepatogastroenterology. 2004; 51(57):757-61. View

14.

Plummer M, Reintam Blaser A, Deane A . Stress ulceration: prevalence, pathology and association with adverse outcomes. Crit Care. 2014; 18(2):213. PMC: 4056012. DOI: 10.1186/cc13780. View

15.

Weimann A, Felbinger T . Gastrointestinal dysmotility in the critically ill: a role for nutrition. Curr Opin Clin Nutr Metab Care. 2016; 19(5):353-359. DOI: 10.1097/MCO.0000000000000300. View

16.

Schubert M . Gastric acid secretion. Curr Opin Gastroenterol. 2016; 32(6):452-460. DOI: 10.1097/MOG.0000000000000308. View

17.

Sigalet D, Mackenzie S, Morad Hameed S . Enteral nutrition and mucosal immunity: implications for feeding strategies in surgery and trauma. Can J Surg. 2004; 47(2):109-16. PMC: 3211926. View

18.

Townsend S, Schorr C, Levy M, Dellinger R . Reducing mortality in severe sepsis: the Surviving Sepsis Campaign. Clin Chest Med. 2008; 29(4):721-33, x. DOI: 10.1016/j.ccm.2008.06.011. View

19.

Pingleton S, Hadzima S . Enteral alimentation and gastrointestinal bleeding in mechanically ventilated patients. Crit Care Med. 1983; 11(1):13-6. DOI: 10.1097/00003246-198301000-00005. View

20.

Cook D, Griffith L, Walter S, Guyatt G, Meade M, Heyland D . The attributable mortality and length of intensive care unit stay of clinically important gastrointestinal bleeding in critically ill patients. Crit Care. 2001; 5(6):368-75. PMC: 83859. DOI: 10.1186/cc1071. View