Borthwick Mark, Jenkins Bethan, Wischmeyer Paul E, Barletta Jeffrey F
Departments of Pharmacy and Critical Care, Oxford University Hospitals NHS Foundation Trust, Oxford.
Department of Dietetics, University Hospital Southampton NHS Foundation Trust, Southampton.
Curr Opin Clin Nutr Metab Care. 2025 Mar 1;28(2):123-128. doi: 10.1097/MCO.0000000000001097. Epub 2024 Dec 10.
Critically ill patients are at risk of gastrointestinal bleeding (GIB) due to stress ulceration. Strategies to reduce the risk include administration of prophylactic ulcer healing medications. Enteral nutrition (EN) may be favourably associated with GIB risks. This manuscript summarizes available evidence regarding EN effects on GIB.
There are few data available to directly compare the effect of EN on GIB. Direct comparison in animal models generally indicate a beneficial effect. Human data provide indirect evidence from pharmacological stress ulcer prophylaxis studies. EN exposure has been randomized in nutrition trials of critically ill patients, but GIB outcomes were not recorded. Detailed EN exposure data were recorded in two large pharmacological stress ulcer trials. One finds EN is associated with lower GIB, lower mortality, and increased pneumonia, and notes a possible interaction between EN and pharmacological stress ulcer prophylaxis. The second has yet to report associations with EN.
EN may reduce the risk of GIB, although robust direct evidence is absent. Potential interactions between EN and pharmacological stress ulcer prophylaxis require further study.
危重症患者因应激性溃疡有发生胃肠道出血（GIB）的风险。降低该风险的策略包括使用预防性溃疡愈合药物。肠内营养（EN）可能与GIB风险存在有利关联。本文总结了关于EN对GIB影响的现有证据。
几乎没有数据可直接比较EN对GIB的影响。动物模型中的直接比较通常显示出有益效果。人体数据从药物性应激性溃疡预防研究中提供了间接证据。在危重症患者的营养试验中，EN暴露已被随机化，但未记录GIB结局。在两项大型药物性应激性溃疡试验中记录了详细的EN暴露数据。一项研究发现EN与较低的GIB、较低的死亡率以及肺炎增加相关，并指出EN与药物性应激性溃疡预防之间可能存在相互作用。第二项研究尚未报告与EN的关联。
尽管缺乏有力的直接证据，但EN可能降低GIB风险。EN与药物性应激性溃疡预防之间的潜在相互作用需要进一步研究。
