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[A clinical study of prevention of stress ulcer]
Insights
Preventing stress ulcer bleeding in high-risk patients proved challenging. Prophylactic ranitidine or ranitidine with somatostatin showed limited success, with bleeding rates around 10%.
Area of Science:
- Gastroenterology
- Critical Care Medicine
- Pharmacology
Background:
- Stress ulcers are a significant cause of bleeding in critically ill patients.
- Previous prophylactic treatments for stress ulcer bleeding have shown varying efficacy.
- High mortality rates are associated with stress ulcer-induced bleeding.
Purpose of the Study:
- To evaluate the effectiveness of ranitidine and ranitidine combined with somatostatin in preventing stress ulcer bleeding.
- To compare the efficacy of these prophylactic treatments against historical data.
- To identify potential factors influencing treatment outcomes.
Main Methods:
- A prophylactic treatment study was conducted on 1012 high-risk patients.
- Patients were randomized into two groups: ranitidine alone (311 patients) and ranitidine plus somatostatin (170 patients).
- Incidence of digestive bleeding was compared between groups and with historical controls.
Main Results:
- The incidence of digestive bleeding was 9.9% in the ranitidine group and 10% in the ranitidine plus somatostatin group.
- These rates were lower than historical controls treated with cimetidine (16.6%) but comparable to anti-acid treatments (8.66%-11.92%).
- The study noted disappointing results, possibly due to patient severity and risk factor duration.
Conclusions:
- Current prophylactic treatments with ranitidine or ranitidine/somatostatin offer limited efficacy in preventing stress ulcer bleeding in severely ill patients.
- The severity and duration of risk factors may significantly impact treatment outcomes.
- Future research should focus on treatments that enhance gastric mucosal defense mechanisms.
Abstract:
The authors have studied the possibilities of preventing digestive bleedings caused by "stress ulcers" in a large number of risk-patients recovered in the Reanimation Center of St. Camillo in Rome. On 1012 patients recovered from 1985 to 1987 the authors have pointed out 69 cases of bleeding by "stress ulcer" (6.9%). The mortality was in these patients 75%. In every patient with risk factors the Authors have performed a prophylactic treatment. This treatment, achieved with randomized standards, has been performed in a group of 311 patients with ranitidine and in a second group of 170 patients with ranitidine and somatostatin joined. In the group of patients treated with ranitidine alone the incidence of digestive bleeding was of 30 patients (9.9%), in the second group treated with ranitidine and somatostatin the incidence was of 18 patients (10%). In a previous study the authors have noted an incidence of digestive bleeding by "stress ulcers" in the 16.6% of patients prophylactically treated with cimetidine and in the 8.66% in a first group of patients treated with anti-acids and in the 11.92% of a second group of patients equally treated with anti-acids. The authors point out that their results are disappointing in opposition to the good results relieved by other Authors possibly in connection with the seriousness, the number and the length of the risk factors in the patients they have treated. They believe that the results will be better when it will be possible to dispose of effective treatment able to increase the defensive powers of the gastric mucosa, seriously impaired by the stress factors.