Stress ulcer prophylaxis in the critically ill: a meta-analysis

Article Abstract:

A stress ulcer is a peptic (stomach, lower esophagus, or upper intestine) ulcer that is caused by acute or chronic stress such as burns, surgery, or infection. Minor bleeding in the affected area of the digestive tract due to these ulcers is common in ill, hospitalized patients. Serious hemorrhages, which cause a high rate of illness and death, are more rare. Stress ulcers develop in the presence of hypotension (low blood pressure) and systemic acidosis (greater acidity in body tissues due to poor removal of carbon dioxide and other waste products), which results in poor stomach blood flow, decreased replacement of stomach cells, and loss of protective mucous membranes. Studies of treatments to prevent stress ulcers, by protecting cells, or reducing or neutralizing gastric acid, have suggested that such prophylactic treatment would benefit many seriously ill patients. However, tests used to define occult (hidden) or other bleeding from the upper gastrointestinal tract may be affected by artifacts, and the benefits of prophylactic therapy may thus be overestimated. To better understand the value of this therapy, the results from 42 studies in this area were analyzed. This investigation confirmed that stress ulcer prophylaxis, using antacids or antihistamines with special affinity for histamine-binding proteins in the digestive tract, benefits critically ill patients by reducing the rate of hemorrhage by half. The histamine receptor blockers were found to be superior to antacids in preventing hemorrhage. Research is needed to identify patients who have low risk of bleeding and thus need not be given prophylactic treatment. (Consumer Summary produced by Reliance Medical Information, Inc.)

Usage, Evaluation, Prevention, Complications and side effects, Gastrointestinal bleeding, Gastrointestinal hemorrhage, Ulcers, Critically ill, Antiulcer agents, Antacids, Antiulcer drugs

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Diagnosis of iron-deficiency anemia in the elderly

Article Abstract:

Iron-deficiency anemia is a common problem in the elderly and may indicate gastrointestinal disease. This type of anemia can be diagnosed by bone marrow aspiration, the sampling of bone marrow tissue by a needle inserted through the skin and bone. Because this invasive procedure is painful and expensive, it is important to determine the accuracy of noninvasive blood tests in diagnosing iron-deficiency anemia in the elderly. Noninvasive diagnostic tests that assess iron stores include: blood level of ferritin, a storage form of iron; mean cell volume; transferrin saturation, the extent to which this iron transport protein is bound to iron; and free erythrocyte protoporphyrin, a derivative of hemoglobin, the oxygen-carrying pigment in the blood. Blood test results were compared with results of bone marrow aspiration in 259 patients over the age of 65 years. Thirty-six percent of patients had no bone marrow iron and were diagnosed as iron-deficient. Of the noninvasive tests, blood ferritin level was the most accurate indicator of iron deficiency. Ferritin values greater than 100 micrograms per liter (ug/L) reduce the probability of iron deficiency to under 10 percent, whereas values of less than 18 ug/L increase the probability of iron deficiency to over 95 percent. The results showed that the prevalence of iron deficiency in this general elderly population was 36 percent, and measurement of blood ferritin levels may be used to reach or disprove a diagnosis of iron deficiency without bone marrow aspiration in 70 percent of patients. (Consumer Summary produced by Reliance Medical Information, Inc.)

Demographic aspects

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Diagnosis of iron-deficiency anemia in a hospitalized geriatric population

Article Abstract:

The blood levels of ferritin, an iron-containing protein, was recently shown to be of value in the diagnosis of iron-deficiency anemia, a decrease in red blood cells associated with iron deficiency. One study of 259 patients with anemia showed that a blood ferritin level of less than 18 micrograms per liter (ug/L), or a combined ferritin level of less than 45 ug/L and transferrin saturation index of less than 0.08, are effective indicators of iron deficiency. The transferrin saturation index is a measure of the levels of transferrin, a protein that binds and transports iron. The value of ferritin levels in diagnosing iron-deficiency anemia in an elderly population was assessed. Of 732 elderly patients, 178 had anemia based on levels of hemoglobin, the oxygen-carrying pigment of red blood cells. Patients with anemia had hemoglobin levels of 115 grams per liter or less shortly after admission. The patient group consisted of 69 men and 109 women, with an average age of 81 years. Analysis of the results showed that ferritin levels were the most important factor in predicting iron deficiency. A blood ferritin level of 50 ug/L or less is strongly indicative of iron depletion. These results are consistent with previous studies. (Consumer Summary produced by Reliance Medical Information, Inc.)

Aged, Elderly, Diseases

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