CHANGING PERSPECTIVES OF STRESS GASTRITIS PROPHYLAXIS

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.