title: Misoprostol versus antacid titration for preventing stress ulcers in postoperative surgical ICU patients.
abstract: Bleeding from gastroduodenal lesions is a potentially life-threatening complication in patients subjected to overwhelming physiologic stress. Titration of gastric contents with antacid was the first prophylactic treatment regimen proved to decrease the incidence of bleeding and remains the standard by which other methods are compared. We designed a prospective double-blind, double-placebo study comparing the effectiveness of antacid titration with fixed doses of a synthetic prostaglandin E1 analog (misoprostol) for preventing stress gastritis and bleeding. To assess the success of each treatment regimen, we did endoscopic examinations before operation, 72 hours after operation, and after the patient had completed the study. A total of 281 patients entered the study (140 misoprostol, 141 antacid). The two groups were comparable with respect to preoperative parameters and type of operation. We found no statistically significant differences between the two treatment groups concerning upper gastrointestinal tract lesions or serious adverse effects. No clinically evident upper gastrointestinal hemorrhage occurred in either group. Mean gastric pH, measured at two-hour intervals during the initial 72 hours, was maintained at 4.0 or higher in both groups. We conclude that fixed-dose misoprostol is as effective as intensive antacid titration in preventing stress ulcers and bleeding in surgical ICU patients.
authors.affiliation: Department of Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland.
authors.forename: M J
authors.initials: MJ
authors.lastname: Zinner
authors.forename: E B
authors.initials: EB
authors.lastname: Rypins
authors.forename: L R
authors.initials: LR
authors.lastname: Martin
authors.forename: O
authors.initials: O
authors.lastname: Jonasson
authors.forename: E L
authors.initials: EL
authors.lastname: Hoover
authors.forename: E A
authors.initials: EA
authors.lastname: Swab
authors.forename: T D
authors.initials: TD
authors.lastname: Fakouhi
mesh_terms: D000328:Adult; D000368:Aged; D000527:Alprostadil / Q000009:adverse effects / Q000627:therapeutic use; D000536:Aluminum Hydroxide / Q000009:adverse effects / Q000627:therapeutic use; D000863:Antacids / Q000009:adverse effects / Q000627:therapeutic use*; D000897:Anti-Ulcer Agents / Q000009:adverse effects / Q000627:therapeutic use*; D003422:Critical Care; D004311:Double-Blind Method; D004338:Drug Combinations / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D006801:Humans; D006863:Hydrogen-Ion Concentration; D008276:Magnesium Hydroxide / Q000009:adverse effects / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D016595:Misoprostol; D015337:Multicenter Studies as Topic; D010437:Peptic Ulcer / Q000209:etiology / Q000517:prevention & control*; D011183:Postoperative Complications / Q000517:prevention & control; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D013312:Stress, Physiological / Q000150:complications*
chemical_list: D000863:Antacids; D000897:Anti-Ulcer Agents; D004338:Drug Combinations; D016595:Misoprostol; C013591:aluminum hydroxide, magnesium hydroxide, drug combination; D000536:Aluminum Hydroxide; D000527:Alprostadil; D008276:Magnesium Hydroxide