[Stress ulcer disease and its prevention].

The incidence and prophylaxis of stress ulcer disease are analyzed. Acute gastroduodenal stress lesions are frequently encountered in critically ill patients, yet the incidence of stress ulcer bleeding has decreased. It is still difficult to describe the risk in an individual patient in spite of the fact that patient groups prone to development of stress ulcer disease have been well defined (e.g. patients on mechanical ventilation). Prophylaxis with antacids, H2-receptor antagonist, pirenzepine and sucralfate seems to be equally effective and capable of reducing the incidence of stress ulcer bleeding. Its efficacy does not really correlate with the capability of a drug to keep gastric pH above 4. The higher the incidence of stress ulcer bleeding under placebo, the better the efficacy of prophylactic treatment. There is evidence that blockers of gastric acid secretion may be associated with an increased incidence of nosocomial pneumonia, but more data are needed in this regard.