Prevention of stress ulcer bleeding: a review.

The pathophysiology of stress ulcers is complex. There is either too much acid and pepsin or inadequate mucosal defenses. The incidence of upper GI bleeding due to stress ulcers in the ICU is 5-25% depending upon the minimum criterion of bleeding. For the individual patient the risk of bleeding is determined by his underlying condition and the number of risk factors. SAPS and APACHE II may assist in identifying those patients. Attainment of an increase in intragastric pH is effective and frequently necessary to prevent stress ulcer bleeding and reduces the incidence of overt bleeding. Based on presently available information the most suitable regime for prevention of stress ulcer bleeding is a continuous infusion or fixed bolus dosing of cimetidine or ranitidine. With respect to the side effects, ranitidine appears to be the more favorable of these two H2 blockers. The position of sucralfate in the prophylaxis has not yet been established.