EROSIVE GASTROPATHIES Hemorrhagic gastritis, multiple gastric erosions. Caused by aspirin and other NSAIDs (lower riskwith newer agents, e.g., nabumetone and etodolac, which do not inhibit gastric mucosal prostaglandins) or severe stress (burns, sepsis, trauma, surgery, shock, or respiratory, renal, or liver failure). May be asymptomatic or associated with epigastric discomfort, nausea, hematemesis, or melena. Diagnosis by upper endoscopy.
Removal of offending agent and maintenance of O2 and blood volume as
required. For prevention of stress ulcers in critically ill pts, hourly oral administration of liquid antacids (e.g., Maalox 30 mL), IV H2-receptor antagonist (e.g., cimetidine, 300-mg bolus _ 37.5–50 mg/h IV), or both is recommended to maintain gastric pH _ 4. Alternatively, sucralfate slurry,
1 g PO q6h, can be given; does not raise gastric pH and may thus avoid increased risk of aspiration pneumonia associated with liquid antacids. Misoprostol, 200_g PO qid, or profound acid suppression (e.g., famotidine, 40 mg PO bid) can be used with NSAIDs to prevent NSAID-induced ulcers.