Stress ulceration: a serious complication in critically ill patients.

The incidence of gastrointestinal bleeding in critically ill patients appears to have declined over the past decade; however, it has not been shown that the incidence of stress ulceration has declined as well. The pathophysiology of stress ulceration is not totally understood, although various factors have been implicated: mucosal barrier breakdown, decreased mucosal blood flow, increased intraluminal acid, decreased epithelial regeneration, and lowered intramural pH. It is widely accepted that prevention is the cornerstone of management for stress ulceration. The critical care nurse must be aware of the importance of monitoring and maintaining a gastric pH greater than 3.5. Antacids, histamine receptor antagonists, sucralfate, and prostaglandins have all been shown to play a role in the treatment of stress ulcerations.