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Konzept der Streßulkusprophylaxe

Concept of stress ulcer prophylaxis: Is a change of mind necessary?

Ist ein Umdenken erforderlich?

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Zusammenfassung

□ Hintergrund

Aufgrund ihrer nachgewiesenen Wirksamkeit zur Verhinderung gastrointestinaler Blutungen beim „kritisch Kranken” hat die Streßulkusprophylaxe eine weite Verbreitung gefunden. Dabei wird sie oft unkritisch bei jedem Intensivpatienten durchgeführt. Die für das letzte Jahrzehnt nachgewiesene niedrigere Inzidenz gastrointestinaler Blutungen bei „kritisch Kranken”, die Nebenwirkungen und die Kosten der Prophylaxe machen ein Umdenken bei der Indikationsstellung zur Streßulkusprophylaxe erforderlich.

□ Indikationen

Ein Risiko einer relevanten gastrointestinalen Blutung besteht nach Metaanalysen nur bei Patienten mit einer Koagulopathie oder einer Beatmungspflicht von mehr als zwei Tagen. Bei Schädelhirntrauma und großflächigen Verbrennungen sowie bei Kreislaufschock ist die Datenlage der bisherigen Studien nicht ausreichend; deshalb wird zur Zeit auch in diesen Fällen eine Streßulkusprophylaxe empfohlen.

Abstract

□ Durchführung

Die Streßulkusprophylaxe sollte mit H2-Blockern (Ranitidin, Famotidin) oder Sucralfat durchgeführt werden, deren Effektivität erst kürzlich in einer großen Metaanalyse bestätigt wurde.

□ Background

The efficiency of stress ulcer prophylaxis in the prevention of gastrointestinal bleeding in critically ill patients has led to its widespread use. The lower incidence of stress ulcer bleeding, the side-effects and the cost of the prophylaxis have made it necessary targeting this preventive therapy to those patients most likely to benefit. Metaanalysis of studies on patients who received no stress ulcer prophylaxis showed few critically ill patients with important gastrointestinal bleeding.

□ Indications

Patients who benefit most from receiving stress ulcer prophylaxis are critically ill patients with coagulopathy, or those requiring mechanical ventilation for more than two days. In patients with headinjuries, widespread burns or severe hypotension, the effects of stress ulcer prophylaxis have not been fully researched, but we would recommend administering stress ulcer prophylaxis in these cases.

□ Treatment

Following a recent metaanalysis, stress ulcer prophylaxis is performed either with H2-blockers (ranitidine, famotidine) or sucralfate.

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  1. Medizinische Klinik C, Klinikum Ludwigshafen gGmbH, Bremserstraße 79, D-67063, Ludwigshafen

    Stephan Kress, Dieter Schilling & Jürgen Ferdinand Riemann

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Kress, S., Schilling, D. & Riemann, J.F. Konzept der Streßulkusprophylaxe. Med Klin 93, 486–491 (1998). https://doi.org/10.1007/BF03042598

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