[Intravenous gastric acid inhibition for stress ulcers and bleeding peptic ulcers]

Intravenous acid inhibition is used in the prevention of upper gastrointestinal bleeding in intensive care unit patients and in the treatment of peptic ulcer bleeding. The strongest risk factors for upper gastrointestinal bleeding are mechanical ventilation for more than 48 hours and coagulopathy. However, a subgroup of critically ill patients without these risk factors may still be at risk of upper gastrointestinal bleeding. Stress ulcer prophylaxis with sucralfate is not effective. Patients who receive intravenous ranitidine (50 mg every 8 hours) run a significantly lower risk of gastrointestinal bleeding. In one study stress ulcer prophylaxis with oral omeprazole was more effective than prophylaxis with intravenous ranitidine. Endoscopic therapy is the cornerstone in modern therapy of peptic ulcer bleeding. Addition of acid inhibition may be effective in preventing clot lysis. H2-receptor antagonists do not influence the natural history of peptic ulcer bleeding. In addition to endoscopic therapy acid inhibition with proton pump inhibitors like omeprazole is more effective than acid inhibition with H2-receptor antagonists. However, the optimal dose and way of administration of omeprazole are not known.