Diagnostic Approach

Endoscopy is the definitive method to diagnose stress ulceration, but is often not feasible in unstable ICU patients.

Diagnosis of stress ulceration is usually presumptive based on:

• Clinical presentation – hematemesis, coffee ground emesis, melena, hematochezia, unexplained anemia, hypotension
• Presence of major risk factors – mechanical ventilation >48 hours, coagulopathy, trauma, sepsis, organ failure
• Exclusion of other potential bleeding sources

Testing:

• Complete blood count – unexplained drop in hemoglobin/hematocrit
• Stool guaiac testing
• Gastric aspirate testing
• Limited role for routine endoscopy given diffuse nature of lesions and risk in unstable patients
• Endoscopy is useful when the bleeding source is unclear or a treatable lesion is suspected
• Biopsies are not useful for diagnosis