[Stress ulcerations: pathogenesis and prevention].

Clinically inapparent gastric stress ulcerations are a frequent complication of extensive trauma, intracranial diseases, burns, sepsis, respiratory insufficiency etc. With improvement of the underlying disease the acute erosions will disappear, however, approximately 20% of the patients will develop major gastro-intestinal bleedings. Besides the known and above mentioned risk factors gastric acid must be present for acute stress lesions to develop. Therefore, attempts at prophylaxis against stress erosions have focused on a decrease of intragastric hydrogen ion concentration. In a number of clinical trials during recent years it was documented that neutralization of gastric content (elevation of intragastric pH to 3.5 or higher) will prevent stress ulcers and their life threatening complication: exsanguinating hemorrhage. Therefore critically ill patients should receive high doses of antacids or cimetidine in combination with antacids to prevent acute stress ulcerations.