Stress-related mucosal bleeding

There is no evidence that inhibiting gastric acid secretion by antisecretory drugs prevents exacerbations of abdominal pain, but they may be used to prevent stress-related mucosal bleeding. 

Intravenous proton pump inhibitors increasingly are being used in critically ill patients to reduce the incidence of stress-related mucosal bleeding despite a lack of any controlled trials demonstrating their efficacy. In the absence of trials that establish efficacy and optimal dosing for proton pump inhibitors, intravenous H2 antagonists remain the preferred drugs for this indication. 

When possible, discontinue medications listed in Table 39-2. Antisecretory drugs may be used to prevent stress-related mucosal bleeding. Octreotide may be tried in severe AP, but its efficacy remains uncertain (see Pig. 39-3). Antibiotics should not be used in the absence of signs of infection except in patients with biliary tract gallstones, or in severe AP when pancreatic necrosis or abscess is... 

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