Gastric Mucosal Changes in Critically-Ill Septic Patients
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- Category: Vol. 78, December 2010
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Gastric Mucosal Changes in Critically-Ill Septic Patients,HAZEM EL-AKABAWY, SHEREEN ELGENGEEHY, YEHIA FAYED, WAHEED RADWAN and ADEL ALSISI
Abstract
Background: Sepsis is one of the major factors that have been associated with an increased risk of development of stress related mucosal disease as a result of the imbalance between factors promoting mucosal injury and host defences.
Purpose: To describe the gastric mucosal morphologic abnormalities occurring in the septic settings, then we attempt-ed to correlate these findings with the clinical course, prognosis and mortality of septic patients.
Methods: A total of 68 critically ill patients with sepsis admitted to the Critical Care Department, Cairo University, were included in a prospective, single center, clinical study. All included septic patients were subjected to the upper GIT endoscope, which was performed at ICU admission and again during ICU stay (approximately one week later) to obtain a gastric mucosal biopsy for histopathological microscopic examination. Clinical outcome (duration of stay in the ICU, need for mechanical ventilation, need for inotropic/vasopressor support, need for haemodialysis, and final outcome of survival/ mortality rates) were recorded for all patients.
Results: The most frequent observed finding of the gastric mucosa in the 1st and the 2nd gastric mucosal biopsies of the study group was the superficial gastritis (SG). The frequency of the SG was decreased from 78% in the 1st biopsies to 33.9% in the 2nd gastric mucosal biopsies. The frequency of the superficial erosions was increased from 1.5% in the 1st biopsies to 22% in the 2nd biopsies. These changes were statistically significant. In the 2nd biopsies, patients with severe sepsis and septic shock showed a statistically significant lower frequency of SG and higher frequency of superficial erosions than those with sepsis. In relation to the 1st gastric mucosal biopsies, 2nd biopsies showed a significantly lower frequency of SG and significantly higher frequency of super-ficial erosions in the septic patients who need mechanical ventilation (p<0.001 for both), those who need inotropic/ vasopressor support (p<0.001 for both) and also, those who need hemodialysis (p<0.001, 0.028 respectively). Non survi-vors showed a significantly lower SG in the 2nd biopsies in relation to the 1st biopsies (p<0.001) and a significantly higher superficial erosion in the 2nd biopsies in relation to the 1st biopsies (p<0.001).
Conclusion: Critically ill septic patient exhibit many degrees of gastric mucosal affection and the severity of these abnormalities exhibit a statistically significant correlation with the morbidity and mortality.