Acute gastro-intestinal bleeding in the critically ill patient.

Endoscopic studies have shown that all critically ill patients are liable to a degree of stress ulceration. Diffuse erosions appear first in the fundus and then spread to the corpus and antrum within 48 h. Duodenal disease is particularly common in burns patients. Discrete ulceration occurs in most severely injured patients. Mucosal damage is probably initiated by ischaemia but only develops in the presence of acid. Although related to the severity of underlying illness, haemorrhage is unpredictable. Mortality is high and largely unaffected by treatment. Emphasis should therefore be made on prophylaxis. Improved intensive reducing intra-luminal acid by antacid or H2 receptor antagonists appears to be the most effective measure, but controlled studies are required.