OBJECTIVE: TO present recent advances in stress gastritis prophylaxis
in the critically ill and review considerations in selection of a prop
hylactic agent. DATA SOURCES: Information was obtained from MEDLINE se
arch, reference lists from articles identified in search, and from rev
iew articles. STUDY SELECTION: Emphasis was placed on controlled trial
s conducted within the last 5 years. DATA EXTRACTION: All literature w
as assessed for methodology, results, and conclusions. Results of pros
pective, randomized trials, and meta-analyses are summarized. DATA SYN
THESIS: Histamine(2)-receptor antagonists, antacids, and sucralfate ap
pear equally effective in preventing stress gastritis in the criticall
y ill. A definitive cause-effect relationship between histamine(2)-rec
eptor antagonists and increased incidence of nosocomial pneumonia has
not yet been established. The indications for using a prophylactic age
nt and consideration in selecting an agent should include an evaluatio
n of the following: risk factors for gastritis including the type of i
ntensive care patient, comparative efficacy, adverse effects, drug int
eractions, cost, and ease of administration. The least expensive, safe
st agent requiring minimal monitoring is sucralfate. Prevention of str
ess gastritis has never been shown to reduce morbidity or mortality si
gnificantly. CONCLUSIONS: Controversies still exist regarding the need
to provide prophylaxis, the choice of an agent, and the relative impo
rtance of previously identified risk factors. Further well-designed st
udies are needed before consensus can be reached.