[Concept of stress ulcer prevention. Is re-thinking necessary?].
BACKGROUND
The efficiency of stress ulcer prophylaxis in the prevention of gastrointestinal bleeding in critically ill patients has led to its widespread use. The lower incidence of stress ulcer bleeding, the side-effects and the cost of the prophylaxis have made it necessary targeting this preventive therapy to those patients most likely to benefit. Metaanalysis of studies on patients who received no stress ulcer prophylaxis showed few critically ill patients with important gastrointestinal bleeding.


METHODS
Patients who benefit most from receiving stress ulcer prophylaxis are critically ill patients with coagulopathy, or those requiring mechanical ventilation for more than two days. In patients with headinjuries, widespread burns or severe hypotension, the effects of stress ulcer prophylaxis have not been fully researched, but we would recommend administering stress ulcer prophylaxis in these cases.


METHODS
Following a recent metaanalysis, stress ulcer prophylaxis is performed either with H2-blockers (ranitidine, famotidine) or sucralfate.
Kress
S
S
Medizinische Klinik C, Klinikum Ludwigshafen.
Schilling
D
D
Riemann
J F
JF
D003362:Cost-Benefit Analysis; D003422:Critical Care / Q000191:economics; D006635:Histamine H2 Antagonists / Q000191:economics / Q000627:therapeutic use; D006801:Humans; D010437:Peptic Ulcer / Q000191:economics / Q000517:prevention & control*; D010438:Peptic Ulcer Hemorrhage / Q000191:economics / Q000517:prevention & control*; D013315:Stress, Psychological / Q000150:complications*; D013392:Sucralfate / Q000191:economics / Q000627:therapeutic use
D006635:Histamine H2 Antagonists; D013392:Sucralfate