Does antacid prophylaxis prevent upper gastrointestinal bleeding in critically ill patients?

Risks and Benefits of Stress Ulcer Prophylaxis for Patients With Severe Sepsis*

“…In the latest version (12), stress ulcer prophylaxis is recommended for patients with a risk of bleeding. Although sepsis itself has been considered as a risk factor for gastrointestinal bleeding (13,14), few studies have investigated the effects of stress ulcer prophylaxis specifically in patients with severe sepsis and the recommendation is based on evidence from the general population in an ICU (15,16). Furthermore, stress ulcer prophylaxis may be associated with an increased risk of ventilator-associated pneumonia (17) or Clostridium difficile (C. difficile) infection (18).…”

Stress Ulceration and Gastric Function in the Critically Ill Patient

“…However these methods yield a high percent age of positive tests and few of these patients actually progress to macroscopic bleeding [3,15,17]. Any patient with macroscopic bleed ing, as manifested by visibly blood-stained gastric aspirates or melaena, should have an endoscopy to confirm the site of bleeding.…”

Stress Ulceration: The Enigma Continues

“…At present, the major mode of prophy laxis against stress ulceration is the mainte nance of a high intragastric pH in seriously ill patients [42,43], Considerable debate has raged about the relative merits of antacids or Hi-receptor blockade in stress ulcer prophy laxis [44]. Such debate has been hindered by the heterogeneous nature of the intercurrent illness and the assessment of the presence or otherwise of stress ulceration.…”