In a decade of burn care at the Royal Adelaide Hospital in South Australia, there have been only two patients (of over 3000) who have displayed clinical evidence of upper gastrointestinal bleeding, with ulceration identified at endoscopy. During this time, all patients admitted to the burns unit with burn injury requiring fluid resuscitation (>15% total body surface area, [TBSA]) routinely received stress ulcer prophylaxis with ranitidine 150 mg, twice daily, from admission to discharge. One of the two patients mentioned had the ranitidine replaced with pantoprazole by our gastroenterological colleagues, who after endoscopic confirmation of ulceration advised us that our prophylaxis regimen was outdated and that proton pump inhibitors (PPI) should replace histamine-2 receptor antagonists (H2RA). With our own intensive care unit (ICU) ceasing pharmacological stress ulcer prophylaxis two years ago (relying on enteral feeding alone to prevent such complications), we searched for burn injuryspecific guidance in the literature.
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