[Rational prevention of stress hemorrhage--effectiveness, side effects, costs]

Stress ulcer bleeding occurs in special risk groups. The main cause of this complication is the loss of protective mechanisms of the gastric mucosa. Preventive measures aim to strengthen the protective mechanisms or to lower the aggressive factors, mainly the gastric acid. Meta-analysis demonstrates that drugs that enhance the protective mechanisms are superior to a regimen that only reduces the secretion of gastric acid. The most important side effects of stress ulcer prophylaxis are related to the inhibition of gastric acid, the blockade of the cytochrome P450 system and the blockade of central and cardiac H2 receptors. Handling difficulties most often occur during treatment with antacids. The costs of prophylaxis are lowest for sucralfate. Rational decision analysis shows that pirenzepine given as parenteral medication and sucralfate as enteral medication are the most suitable drugs for stress ulcer prophylaxis.