[Prevention of stress ulcer: A practical approach]

Critically ill patients are at risk to develop stress ulceration of the gastric mucosa. Although the evidence for efficacity of specific medications to prevent stress ulcer is discordant, there is general agreement in favor of prophylaxis to prevent stress ulceration in patients at high risk - i.e., surgical patients in the ICU setting with mechanical ventilation, anticoagulation, or instability. Although no medication is specifically authorized in France for this indication, H2 blockers and proton pump inhibitors (PPI's) are generally the agents of choice. While PPI's are the most potent inhibitors of gastric acidity, no evidence exists to prove their superior efficacity. Numerous questions remain unanswered (which drug? at what dose? for how long?) which underline the need to develop intra-institutional consensus.