Treatment of stress ulcers in acute stroke patients at neurologic intensive care unit

Stroke is one of the most common causes of morbidity and mortality in the world population. Recent literature identifies a plenty of risk factors that play an important role in the genesis of stroke and describes numerous systemic poststroke complications. Only a few studies of post stroke complications refer to severe gastrointestinal hemorrhage attributed to stress ulcers, emergency endoscopic findings, and therapeutic procedure. This prospective study conducted between January 2003 and January 2004 included 540 acute stroke patients admitted to Neurologic Intensive Care Unit, 17 of them with clinical signs of massive gastrointestinal bleeding due to stress ulcers after stroke. All these patients underwent urgent endoscopy within 24 h of initial gastrointestinal bleeding and "second look endoscopy" after 72 h. Gastrointestinal bleeding was recorded in 17 (3.18%) of 540 stroke patients, including nine patients with stomach ulcer, five patients with duodenal bulb ulcer, and three patients with massive hemorrhagic erosive gastritis. In all patients with ulcer disease initial hemostasis was achivieved endoscopically by injection of fibrin glue, by polidocanol, or by placement of hemostatic clips, followed by intravenous administration proton pump inhibitors or octreotide. Second look endoscopy showed ulcer good healing without signs of potential new bleeding. Our study showed a relatively low rate (3.18%) of gastrointestinal bleeding in patients with recent stroke and a high risk (15.1%) of gastrointestinal bleeding among mechanically ventilated patients, which is consistent with literature data. All patients with bleeding stress gastric or duodenal ulcers were successfully treated endoscopically. Control endoscopy after 72 h showed good healing of ulcers, without visible vessels. None of these patients required surgery.