The combined data from 16 prospective trials (2133 patients) appear to suggest that antacids prevent stress ulcer bleeding more effectively than does cimetidine. However, the use of occult blood detection methods to diagnose stress ulcer bleeding may have led to the recognition of clinically insignificant bleeding. When the data from these trials are categorized according to the criteria used for the diagnoses of bleeding (either occult blood detection or clinically overt bleeding), there was no significant difference between antacids and cimetidine in the prevention of overt bleeding (3.3% of 458 compared with 2.7% of 402 patients who bled, respectively; p = 0.69). In addition, both agents were more effective (p less than 0.001) than placebo (15% of 720 patients who bled) in the prevention of overt bleeding. Cimetidine and antacids are equal in preventing significant stress ulcer bleeding.
MO 63110.Stress ulcer syndrome refers to gastroduodenal erosions or ulcers that develop acutely in relation to major physiological stress, usually manifested clinically as upper gastrointestinal (UGI) bleeding. These lesions occur most often in the gastric fundus. Endoscopy has shown gastroduodenal mucosal lesions in 75 to 100% of intensive care unit (ICU) patients within 72 hours of admission. Patients at high risk for stress ulcer include those with large body surface area burns, intracranial lesions associated with coma, fulminant hepatic failure, sepsis, and trauma and abdominal, cardiovascular, and thoracic surgery patients. Also considered high risk are ICU patients with superimposed complications such as shock, mechanical ventilation for more than 3 days, coagulopathy, jaundice, and sepsis. Approximately 15% of ICU patients will experience UGI bleeding from stress ulcer. Patients bleeding from stress ulcer have an overall mortality rate approaching 65% compared with 9 to 22% mortality in patients without stress ulcer. When stratified according to occult blood loss versus clinically significant bleeding, mortality can be as high as 90% in patients overtly bleeding; 30% of deaths are directly related to bleeding. Both antacids and H 2 receptor antagonists are effective in prophylaxis for stress ulcer bleeding.Gastrointestinal bleeding is a major problem in intensive care medicine, and upper gastrointestinal (UGI) hemorrhage may occur in 10% or more of intensive care unit (ICU) patients [1]. Bleeding representing the usual spectrum of UGI mucosal lesions can be responsible for admission to the ICU, but bleeding can also be a secondary complication that occurs during the ICU stay. The latter has been referred to as the clinical syndrome of &dquo;stress ulcer.&dquo; Stress ulcers are acutely formed defects in the gastroduodenal mucosa that develop in a critically ill patient with a severe physiological derangement.
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