PROSPECTIVE ENDOSCOPIC STUDY OF STRESS EROSIONS AND ULCERS IN CRITICALLY ILL ADULT PATIENTS TREATED WITH EITHER SUCRALFATE OR PLACEBO

Objective: To compare the frequency of stress erosions and ulcers in c ritically ill adult patients treated with either sucralfate or placebo . Design: Prospective, randomized study. Setting: Intensive care unit in a university hospital. Patients: Twenty-six adult patients. All pat ients were mechanically ventilated and were at risk of developing stre ss ulceration. Interventions: Patients were randomized to receive eith er sucralfate (2 g every 8 hrs) (group 1) via the nasogastric tube (fl ushed with 10 mL, of sterile water) or 20 mL of sterile water every 8 hrs (group 2) via the nasogastric tube.Measurements and Main Results: At the time of intensive care unit admission, the frequency of stress (acute) erosions (as assessed with the endoscope) was 21.7%. No ulcers were detected. By day 3, the frequency had increased to 37.5% in grou p 1 and 88.9% in group 2. Mucosal deterioration was more likely in the patients treated with placebo (water) (p < .05). In total, seven pati ents developed acute ulceration in group 2 compared with only one pati ent in group 1 (p < .05). The frequency of gastric colonization with a erobic Gram-negative bacilli was 25.6% in group 1 and 28.6% in group 2 . Only one retrograde nosocomial pneumonia developed (group 1). Conclu sion: Based on our findings, we strongly recommend the adoption of suc ralfate as opposed to no prophylaxis in the prevention of acute upper gastrointestinal ulceration.