Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Current Nutrition Reports
Published in: Current Nutrition Reports 3/2018

01-09-2018 | Gastroenterology, Critical Care, and Lifestyle Medicine (SA McClave, Section Editor)

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

Authors: Carolyn Newberry, Jessica Schucht

Published in: Current Nutrition Reports | Issue 3/2018

Login to get access

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.

Summary

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.
Literature
1.
2.
•• Huang H, Jiang W, Wang C, Qin H, Du B. Stress ulcer prophylaxis in intensive care unit patients receiving enteral nutrition: a systematic review and meta-analysis. Crit Care. 2018;22(1):20. Most recent meta-analysis showing lack of benefit of AST In patients receiving enteral nutrition.CrossRefPubMedPubMedCentral
3.
Kantorova I, Svoboda P, Scheer P, Doubek J, Rehorkova D, Bosakova H, et al. Stress ulcer prophylaxis in critically ill patients: a randomized controlled trial. Hepato-Gastroenterology. 2004;51(57):757–61.PubMed
4.
Marik PE, Vasu T, Hirani A, Pachinburavan M. Stress ulcer prophylaxis in the new millennium: a systematic review and meta-analysis. Crit Care Med. 2010;38(11):2222–8.CrossRefPubMed
5.
Hurt RT, Frazier TH, McClave SA, Crittenden NE, Kulisek C, Saad M, et al. Stress prophylaxis in intensive care unit patients and the role of enteral nutrition. JPEN J Parenter Enteral Nutr. 2012;36(6):721–31.CrossRefPubMed
6.
Cook DJ, Fuller HD, Guyatt GH, Marshall JC, Leasa D, Hall R, et al. Risk factors for gastrointestinal bleeding in critically ill patients. Canadian Critical Care Trials Group. N Engl J Med. 1994;330(6):377–81.CrossRefPubMed
7.
Cook DJ, Reeve BK, Guyatt GH, Heyland DK, Griffith LE, Buckingham L, et al. Stress ulcer prophylaxis in critically ill patients. Resolving discordant meta-analyses. JAMA. 1996;275(4):308–14.CrossRefPubMed
8.
Bardou M, Quenot J, Barkun A. Stress-related mucosal disease in the critically ill patient. Nat Rev Gastroenterol Hepatol. 2015;12(2):98–107.CrossRefPubMed
9.
10.
Cook DJ, Griffith LE, Walter SD, Guyatt GH, Meade MO, Heyland DK, et al. 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.CrossRefPubMedPubMedCentral
11.
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. 2014;48(2):113–8.CrossRefPubMed
12.
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.CrossRefPubMed
13.
Krag M, Perner A, Wetterslev J, Wise M, Hylander Møller M. Stress ulcer prophylaxis versus placebo or no prophylaxis in critically ill patients. Intensive Care Med. 2014;40(1):11–22.CrossRefPubMed
14.
Farrell CP, Mercogliano G, Kuntz CL. Overuse of stress ulcer prophylaxis in the critical care setting and beyond. J Crit Care. 2010;25(2):214–20.CrossRefPubMed
15.
Spirt MJ. Stress-related mucosal disease: risk factors and prophylactic therapy. Clin Ther. 2004;26(2):197–213.CrossRefPubMed
16.
Veitch AM, Baglin TP, Gershlick AH, Harnden SM, Tighe R, Cairns S. Guidelines for the management of anticoagulant and antiplatelet therapy in patients undergoing endoscopic procedures. Gut. 2008;57(9):1322–9.CrossRefPubMed
17.
Menguy R, Masters YF. Mechanism of stress ulcer. II. Differences between the antrum, corpus, and fundus with respect to the effects of complete ischemia on gastric mucosal energy metabolism. Gastroenterology. 1974;66(4):509–16.PubMed
18.
Townsend SR, Schorr C, Levy MM, Dellinger RP. Reducing mortality in severe Sepsis: the surviving sepsis campaign. Clin Chest Med. 2008;29(4):721–33.CrossRefPubMed
19.
Stollman N, Metz DC. Pathophysiology and prophylaxis of stress ulcer in intensive care unit patients. J Crit Care. 2005;20(1):35–45.CrossRefPubMed
20.
Metz CA, Livingston DH, Smith JS, Larson GM, Wilson TH. 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.CrossRefPubMed
21.
Martin LF, Booth FV, Karlstadt RG, Silverstein JH, Jacobs DM, Hampsey J, et al. Continuous intravenous cimetidine decreases stress-related upper gastrointestinal hemorrhage without promoting pneumonia. Crit Care Med. 1993;21(1):19–30.CrossRefPubMed
22.
Singh H, Houy TL, Singh N, Sekhon S. Gastrointestinal prophylaxis in critically ill patients. Crit Care Nurs Q. 2008;31(4):291–301.CrossRefPubMed
23.
Alhazzani W, Alshamsi F, Belley-Cote E, Heels-Ansdell D, Brignardello-Petersen R, Alquraini M, et al. Efficacy and safety of stress ulcer prophylaxis in critically ill patients: a network meta-analysis of randomized trials. Intensive Care Med. 2018;44(1):1–11.CrossRefPubMed
24.
Barletta JF, Kanji S, MacLaren R, Lat I, Erstad BL. Pharmacoepidemiology of stress ulcer prophylaxis in the United States and Canada. J Crit Care. 2014;29(6):955–60.CrossRefPubMed
25.
Selvanderan SP, Summers MJ, Finnis ME, Plummer MP, Ali Abdelhamid Y, Anderson MB, et al. Pantoprazole or placebo for stress ulcer prophylaxis (POP-UP): randomized double-blind exploratory study. Crit Care Med. 2016;44(10):1842–50.CrossRefPubMed
26.
Zandstra DF, Stoutenbeek CP. The virtual absence of stress-ulceration related bleeding in ICU patients receiving prolonged mechanical ventilation without any prophylaxis. A prospective cohort study. Intensive Care Med. 1994;20(5):335–40.CrossRefPubMed
27.
Pfau PR, Cooper GS, Carlson MD, Chak A, Sivak MV, Gonet JA, et al. 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.CrossRefPubMed
28.
McClave SA, Taylor BE, Martindale RG, Warren MM, Johnson DR, Braunschweig C, et al. Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient. J Parenter Enter Nutr. 2016;40(2):159–211.CrossRef
29.
Elke G, Wang M, Weiler N, Day AG, Heyland DK. Close to recommended caloric and protein intake by enteral nutrition is associated with better clinical outcome of critically ill septic patients: secondary analysis of a large international nutrition database. Crit Care (London, England). 2014;18(1):R29.CrossRef
30.
Kondrup J. Nutritional-risk scoring systems in the intensive care unit. Curr Opin Clin Nutr Metab Care. 2014;17(2):177–82.CrossRefPubMed
31.
Engmann J, Burbidge AS. Fluid mechanics of eating, swallowing and digestion—overview and perspectives. Food Funct. 2013;4(3):443–7.CrossRefPubMed
32.
33.
McDermott AJ, Huffnagle GB. The microbiome and regulation of mucosal immunity. Immunology. 2013;142(1):24–31.CrossRef
34.
35.
36.
Hsu T, Su C, Huang P, Lu S, Tsai S. Comparison of tolerance and change of intragastric pH between early nasogastric and nasojejunal feeding following resection of colorectal cancer. Clin Nutr. 2006;25(4):681–6.CrossRefPubMed
37.
Ephgrave KS, Kleiman-Wexler RL, Adair CG. Enteral nutrients prevent stress ulceration and increase intragastric volume. Crit Care Med. 1990;18(6):621–4.CrossRefPubMed
38.
Sigalet DL, Mackenzie SL, Hameed SM. Enteral nutrition and mucosal immunity: implications for feeding strategies in surgery and trauma. Can J Surg. 2004;47(2):109–16.PubMedPubMedCentral
39.
Armstrong D, Castiglione F, Emde C, Cilluffo T, Duroux P, Koerfer J, et al. The effect of continuous enteral nutrition on gastric acidity in humans. Gastroenterology. 1992;102(5):1506–15.CrossRefPubMed
40.
Bonten MJ, Gaillard CA, van Tiel FH, van dG, Stobberingh EE. Continuous enteral feeding counteracts preventive measures for gastric colonization in intensive care unit patients. Crit Care Med. 1994;22(6):939–44.CrossRefPubMed
41.
Schörghuber M, Fruhwald S. Effects of enteral nutrition on gastrointestinal function in patients who are critically ill. Lancet Gastroenterol Hepatol. 2018;3(4):281–7.CrossRefPubMed
42.
Weimann A, Felbinger TW. Gastrointestinal dysmotility in the critically ill: a role for nutrition. Curr Opin Clin Nutr Metab Care. 2016.
43.
•• El-Kersh K, Jalil B, McClave SA, Cavallazzi R, Guardiola J, Guilkey K, et al. Enteral nutrition as stress ulcer prophylaxis in critically ill patients: a randomized controlled exploratory study. J Crit Care. 2018;43:108. Recent single center RCT comparing outcomes between critically ill patients receiving enteral nutrition and IV AST vs enteral nutrition and IV placebo showing no difference in bleeding rates.CrossRefPubMed
44.
Pingleton SK, Hadzima SK. Enteral alimentation and gastrointestinal bleeding in mechanically ventilated patients. Crit Care Med. 1983;11(1):13–6.CrossRefPubMed
45.
Choctaw WT, Fujita C, Zawacki BE. Prevention of upper gastrointestinal bleeding in burn patients: a role for 'elemental' diet. Arch Surg. 1980;115(9):1073–6.CrossRefPubMed
46.
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.CrossRefPubMed
47.
Palm NM, McKinzie B, Ferguson PL, Chapman E, Dorlon M, Eriksson EA, et al. Pharmacologic stress gastropathy prophylaxis may not be necessary in at-risk surgical trauma ICU patients tolerating enteral nutrition. J Intensive Care Med. 2018;33(7):424–29.
Metadata
Title
Use of Enteral Nutrition for Gastrointestinal Bleeding Prophylaxis in the Critically Ill: Review of Current Literature
Authors
Carolyn Newberry
Jessica Schucht
Publication date
01-09-2018
Publisher
Springer US
Published in
Current Nutrition Reports / Issue 3/2018
Electronic ISSN: 2161-3311
DOI
https://doi.org/10.1007/s13668-018-0232-3

Other articles of this Issue 3/2018

Current Nutrition Reports 3/2018 Go to the issue

Neurological Disease and Cognitive Function (Y Gu, Section Editor)

The Role of Diet in Multiple Sclerosis: Mechanistic Connections and Current Evidence

Gastroenterology, Critical Care, and Lifestyle Medicine (SA McClave, Section Editor)

Impact of Energy Drinks on Health and Well-being

Gastroenterology, Critical Care, and Lifestyle Medicine (SA McClave, Section Editor)

Are We Going Nuts on Coconut Oil?

Neurological Disease and Cognitive Function (Y Gu, Section Editor)

The Role of Nutrition in Cognitive Function and Brain Ageing in the Elderly

Cancer (MF Leitzmann, Section Editor)

Folate and Its Impact on Cancer Risk

Gastroenterology, Critical Care, and Lifestyle Medicine (SA McClave, Section Editor)

From Religion to Secularism: the Benefits of Fasting

ACC 2024 Congress Coverage

Heart Failure Video

Year in Review: Heart failure and cardiomyopathies

Watch now

Watch this official video from ACC.24. Dr. Biykem Bozkurt discuss last year's major advances in heart failure and cardiomyopathies.

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

16-04-2024 Type 2 Diabetes News

Incentivised to exercise

11-04-2024 Lifestyle Modifications News

New intervention for STEMI-related cardiogenic shock

10-04-2024 Myocardial Infarction News

» View more highlights on the ACC 2024 congress hub page

Image Credits