Changing perspectives of stress gastritis prophylaxis.
OBJECTIVE
To present recent advances in stress gastritis prophylaxis in the critically ill and review considerations in selection of a prophylactic agent.


METHODS
Information was obtained from MEDLINE search, reference lists from articles identified in search, and from review articles.


METHODS
Emphasis was placed on controlled trials conducted within the last 5 years.


METHODS
All literature was assessed for methodology, results, and conclusions. Results of prospective, randomized trials, and meta-analyses are summarized.


RESULTS
Histamine2-receptor antagonists, antacids, and sucralfate appear equally effective in preventing stress gastritis in the critically ill. A definitive cause-effect relationship between histamine2-receptor antagonists and increased incidence of nosocomial pneumonia has not yet been established. The indications for using a prophylactic agent and consideration in selecting an agent should include an evaluation of the following: risk factors for gastritis including the type of intensive care patient, comparative efficacy, adverse effects, drug interactions, cost, and ease of administration. The least expensive, safest agent requiring minimal monitoring is sucralfate. Prevention of stress gastritis has never been shown to reduce morbidity or mortality significantly.


CONCLUSIONS
Controversies still exist regarding the need to provide prophylaxis, the choice of an agent, and the relative importance of previously identified risk factors. Further well-designed studies are needed before consensus can be reached.
Smythe
M A
MA
Department of Pharmacy Practice, Wayne State University, Detroit, MI 48202.
Zarowitz
B J
BJ
D000863:Antacids / Q000627:therapeutic use*; D018849:Controlled Clinical Trials as Topic; D016638:Critical Illness; D005756:Gastritis / Q000209:etiology / Q000517:prevention & control*; D006471:Gastrointestinal Hemorrhage / Q000150:complications; D006635:Histamine H2 Antagonists / Q000627:therapeutic use*; D006801:Humans; D015201:Meta-Analysis as Topic; D011446:Prospective Studies; D013312:Stress, Physiological / Q000517:prevention & control*; D013392:Sucralfate / Q000627:therapeutic use*
D000863:Antacids; D006635:Histamine H2 Antagonists; D013392:Sucralfate