Stress Ulceration Treatment

Ranitidine and sucralfate are the most effective agents. Ranitidine is associated with a lower incidence of clinically significant bleeding, sucralfate with a lower incidence of pneumonia.

The prevention of stress ulceration has focused on reducing the quantity of luminal acid, using H2 receptor antagonists or antacids. The overall objective of such therapy is to increase the pH of the stomach above 3.5. Multiple studies have compared H2 antagonists to sucralfate, a cytoprotectant agent, given as a gel which turns into a foam and coats the stomach on contact with acid. A large randomized controlled trial by Cooke and colleagues (4), remains the best source of data available. In this study, which compared the H2 antagonist ranitidine to sucralfate, the incidence of clinically important GI bleeding was 1.7% in the ranitidine group, compared with 3.8% in the sucralfate group (p=0.02). In absolute terms this represented 10 bleeds in 596 patients receiving ranitidine, and 23 bleeds in 604 patients receiving sucralfate; a very low overall incidence of bleeding. Interesting, a series of meta-analyses by Messori (9)failed to demonstrate a difference between both ranitidine and sucralfate as compared with placebo. There is little data available with regard to other anti-acid therapy, such as proton pump inhibitors, in the intensive care setting.

Please note: these tutorials are for personal study purposes only.  They are not currently peer reviewed, and no responsibility will be taken for mistakes or inaccuracies. Reproduction of information is forbidden. All material is copyrighted by the GasWorks Group.