Stress-Induced Gastritis Medication

  • Author: Rohan C Clarke, MD; Chief Editor: Julian Katz, MD   more...
 
Updated: Jul 22, 2011
 

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.

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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).

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Famotidine (Pepcid)

 

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

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Nizatidine (Axid)

 

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

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Cimetidine (Tagamet)

 

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

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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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Contributor Information and Disclosures
Author

Rohan C Clarke, MD  Consulting Staff, 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, and American Society of Gastrointestinal Endoscopy

Disclosure: Salix Honoraria Round table feedback group

Coauthor(s)

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, and American Osteopathic Association

Disclosure: Nothing to disclose.

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, and 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, and Association of Black Cardiologists

Disclosure: Nothing to disclose.

Specialty Editor Board

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.

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

Disclosure: Medscape Salary Employment

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.

Alex J Mechaber, MD, FACP  Senior Associate Dean for Undergraduate Medical Education, Associate Professor of Medicine, University of Miami Miller School of Medicine

Alex J Mechaber, MD, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, and Society of General Internal Medicine

Disclosure: Nothing to disclose.

Chief Editor

Julian Katz, MD  Clinical Professor of Medicine, Drexel University College of Medicine

Julian Katz, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Geriatrics Society, American Medical Association, American Society for Gastrointestinal Endoscopy, American Society of Law, Medicine & Ethics, American Trauma Society, Association of American Medical Colleges, and Physicians for Social Responsibility

Disclosure: Nothing to disclose.

References

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

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

  3. 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. Sep 15 2009;epub ahead of print. [Medline].

  4. 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. Jun 13 2011;171(11):991-7. [Medline].

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

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

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

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

  9. 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. Jan 12 1998;158(1):54-8. [Medline].

  10. 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. Aug 2009;30(8):1460-5. [Medline].

  11. 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. Dec 11 2009;epub ahead of print. [Medline].

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

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

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

 
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