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Stress-Induced Gastritis Medication

  • Author: Rohan C Clarke, MD; Chief Editor: BS Anand, MD  more...
 
Updated: Jun 25, 2015
 

Medication Summary

The goals of pharmacotherapy are to reduce morbidity and to prevent complications.

PPIs have not been fully evaluated in the role of prophylaxis for this disease.

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Gastrointestinal agents

Class Summary

Shown to be effective in the prevention of stress-induced gastritis.

Sucralfate (Carafate)

 

Binds with positively charged proteins in exudates and forms a viscous adhesive substance that protects the GI lining against pepsin, peptic acid, and bile salts. Primary agent for prophylaxis of stress gastritis.

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Histamine H2 antagonists

Class Summary

These agents block H2 receptor binding. The primary indication is to reduce symptoms and to accelerate healing of gastric ulcers. In the acutely bleeding patient, they are of limited benefit. Some have also been used for prophylaxis (eg, famotidine).

Famotidine (Pepcid)

 

Competitively inhibits histamine at H2 receptor of gastric parietal cells, resulting in reduced gastric acid secretion, gastric volume, and hydrogen ion concentrations.

Nizatidine (Axid)

 

Competitively inhibits histamine at H2 receptors of gastric parietal cells, resulting in reduced gastric acid secretion, gastric volume, and reduced hydrogen concentrations.

Cimetidine (Tagamet)

 

Inhibits histamine at H2 receptors of gastric parietal cells, which results in reduced gastric acid secretion, gastric volume, and hydrogen concentrations.

Ranitidine (Zantac)

 

Inhibits histamine stimulation of the H2 receptor in gastric parietal cells, which, in turn, reduces gastric acid secretion, gastric volume, and hydrogen ion concentrations.

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Proton Pump Inhibitor

Class Summary

Proton pump inhibitors are inhibitors of the gastric H+/K+ -ATPase (proton pump) enzyme system, which catalyzes the exchange of H+ and K+.

Esomeprazole (Nexium)

 

S-isomer of omeprazole. Inhibits gastric acid secretion by inhibiting H+/K+ -ATPase enzyme system at secretory surface of gastric parietal cells.

Used in severe cases of and patients not responding to H2 antagonist therapy.

Used for up to 4 wk to treat and relieve symptoms of active duodenal ulcers; may be used up to 8 wk to treat all grades of erosive esophagitis.

Pantoprazole (Protonix)

 

Pantoprazole suppresses gastric acid secretion by specifically inhibiting the H+/K+-ATPase enzyme system at the secretory surface of gastric parietal cells. Use of the intravenous preparation has only been studied for short-term use (ie, 7-10 d).

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Contributor Information and Disclosures
Author

Rohan C Clarke, MD Director, Department of Gastroenterology, JPS Health Systems Hospital

Rohan C Clarke, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Society for Gastrointestinal Endoscopy

Disclosure: Serve(d) as a speaker or a member of a speakers bureau for: Cubist; <br/>Received reimbursement from Boston Scientific for learning observership for eus; Received honoraria from Optimer pharmaceutical for speaking and teaching.

Coauthor(s)

Emmanuel Gbadehan, MD Instructor in Clinical Medicine, Columbia University College of Physicians and Surgeons; Consulting Staff, Department of Gastroenterology, Harlem Hospital Center, North General Hospital

Emmanuel Gbadehan, MD is a member of the following medical societies: American College of Physicians, American College of Physicians-American Society of Internal Medicine, American Gastroenterological Association, American Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Uzodinma R Dim, MD Clinical Cardiac Electrophysiology Fellow, Division of Cardiovascular Medicine, University of Iowa Hospital and Clinics

Uzodinma R Dim, MD is a member of the following medical societies: American College of Cardiology, American College of Physicians, American Heart Association, American Medical Association, Association of Black Cardiologists

Disclosure: Nothing to disclose.

Rachael M Ferraro, DO Internal Medicine Hospitalist, Torrance Memorial Medical Center, Little Company of Mary Hospital

Rachael M Ferraro, DO is a member of the following medical societies: American College of Osteopathic Internists, American College of Physicians, American Osteopathic Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

BS Anand, MD Professor, Department of Internal Medicine, Division of Gastroenterology, Baylor College of Medicine

BS Anand, MD is a member of the following medical societies: American Association for the Study of Liver Diseases, American College of Gastroenterology, American Gastroenterological Association, American Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Additional Contributors

Ann Ouyang, MBBS Professor, Department of Internal Medicine, Pennsylvania State University College of Medicine; Attending Physician, Division of Gastroenterology and Hepatology, Milton S Hershey Medical Center

Disclosure: Nothing to disclose.

Acknowledgements

Simmy Bank, MD Chair, Professor, Department of Internal Medicine, Division of Gastroenterology, Long Island Jewish Hospital, Albert Einstein College of Medicine

Disclosure: Nothing to disclose.

References
  1. Kwiecien S, Ptak-Belowska A, Krzysiek-Maczka G, et al. Asymmetric dimethylarginine, an endogenous inhibitor of nitric oxide synthase, interacts with gastric oxidative metabolism and enhances stress-induced gastric lesions. J Physiol Pharmacol. 2012 Oct. 63(5):515-24. [Medline].

  2. Yardley JH, Hendrix TR. Textbook of Gastroenterology. 2nd ed. Philadelphia, Pa: JB Lippincott Co; 2001. 1456-93.

  3. Feldman M. Friedman LS, Sleisenger MH, eds. Sleisenger & Fordtran's Gastrointestinal and Liver Disease. 7th ed. Philadelphia, Pa: WB Saunders Co; 2002. 587-603.

  4. Constantin VD, Paun S, Ciofoaia VV, Budu V, Socea B. Multimodal management of upper gastrointestinal bleeding caused by stress gastropathy. J Gastrointestin Liver Dis. 2009 Sep. 18(3):279-84. [Medline].

  5. Reveiz L, Guerrero-Lozano R, Camacho A, Yara L, Mosquera PA. Stress ulcer, gastritis, and gastrointestinal bleeding prophylaxis in critically ill pediatric patients: A systematic review*. Pediatr Crit Care Med. 2009 Sep 15. epub ahead of print. [Medline].

  6. Frandah W, Colmer-Hamood J, Nugent K, Raj R. Patterns of Use of Prophylaxis for Stress-Related Mucosal Disease in Patients Admitted to the Intensive Care Unit. J Intensive Care Med. 2012 Jul 10. [Medline].

  7. Pilkington KB, Wagstaff MJ, Greenwood JE. Prevention of gastrointestinal bleeding due to stress ulceration: a review of current literature. Anaesth Intensive Care. 2012 Mar. 40(2):253-9. [Medline].

  8. Herzig SJ, Vaughn BP, Howell MD, Ngo LH, Marcantonio ER. Acid-suppressive medication use and the risk for nosocomial gastrointestinal tract bleeding. Arch Intern Med. 2011 Jun 13. 171(11):991-7. [Medline].

  9. Alan N Barkun MD, MSc, Marc Bardou MD, PhD, C Q D Pham PharmD, and Myriam Martel BSc. Proton Pump Inhibitors vs. Histamine 2 Receptor Antagonists for Stress-Related Mucosal Bleeding Prophylaxis in Critically Ill Patients: A Meta-Analysis. Am J Gastroenterol doi:10.1038/ajg.2011.474. 1/2012. 107:507-520. [Full Text].

  10. Fiddian-Green RG, McGough E, Pittenger G. Predictive value of intramural pH and other risk factors for massive bleeding from stress ulceration. Gastroenterology. 1983 Sep. 85(3):613-20.

  11. Harrison L. PPI riskier than H2 for stress ulcer prophylaxis. Medscape Medical News. January 16, 2014. Available at http://www.medscape.com/viewarticle/819303. Accessed: January 17, 2014.

  12. Irwin R, Rippe J. Manual of Intensive Care Medicine. Philadelphia, Pa: JB Lippincott Co; 2001.

  13. Khuroo MS, Yattoo GN, Javid G. A comparison of omeprazole and placebo for bleeding peptic ulcer. N Engl J Med. 1997 Apr 10. 336(15):1054-8.

  14. Laine L. Sleisenger & Fordtran's Gastrointestinal and Liver Disease. 6th ed. Philadelphia: WB Saunders;. 2000:198-219.

  15. Lin HJ, Lo WC, Lee FY. A prospective randomized comparative trial showing that omeprazole prevents rebleeding in patients with bleeding peptic ulcer after successful endoscopic therapy. Arch Intern Med. 1998 Jan 12. 158(1):54-8. [Medline].

  16. Petronilho F, Araujo JH, Steckert AV, et al. Effect of a gastrin-releasing peptide receptor antagonist and a proton pump inhibitor association in an animal model of gastritis. Peptides. 2009 Aug. 30(8):1460-5. [Medline].

  17. Sadaka F, Trottier S, Smith T, et al. Proton pump inhibitors versus histamine 2 receptor antagonists for stress ulcer prophylaxis (abstract 894). Crit Care Med. 2013;41(12):A222. Presented at: Society of Critical Care Medicine (SCCM) 43rd Critical Care Congress; January 11, 2014; San Francisco, Calif.

  18. van Mark A, Spallek M, Groneberg DA, Kessel R, Weiler SW. Correlates shift work with increased risk of gastrointestinal complaints or frequency of gastritis or peptic ulcer in H. pylori-infected shift workers?. Int Arch Occup Environ Health. 2009 Dec 11. epub ahead of print. [Medline].

  19. Wolfe M. Stress-related erosive syndrome. Bayless T, ed. Current Therapy in Gastroenterology and Liver Disease. 4th ed. St Louis, Mo: Mosby; 1994. 139-43.

  20. Wolfe MM, Sachs G. Acid suppression: optimizing therapy for gastroduodenal ulcer healing, gastroesophageal reflux disease, and stress-related erosive syndrome. Gastroenterology. 2000 Feb. 118(2 Suppl 1):S9-31.

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