Recognizing, setting therapeutic goals, and selecting therapy for the prevention and treatment of stress-related...

Advances in the care of critically ill patients and in diagnostic techniques, such as fiberoptic endoscopy, have enabled greater recognition of stress-related mucosal damage (SRMD). This condition is distinguished from chronic peptic ulcer disease by its greater number of lesions, proximal location in the acid-producing portion of the stomach, and superficial bleeding. Endoscopy is considered the best method for detecting and monitoring mucosal damage. The onset of SRMD occurs early, within hours of the traumatic insult. Pharmacologic treatment has been oriented toward suppressing intraluminal acid and enhancing mucosal defense mechanisms. Antacid therapy is considered the best method for treatment of SRMD, although extensive experience has been gained with the H2-receptor antagonists. The vast majority of experience with the H2-receptor antagonists has been with cimetidine, which is as effective as antacids, as shown by endoscopy. Investigations of alternative forms of therapy (e.g., prostaglandins) are in progress.