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Prophylactic therapy for stress ulcer bleeding: a reappraisal
Annals of Internal Medicine
|April 1, 1987
Summary
Antacids and cimetidine are equally effective in preventing significant stress ulcer bleeding. While initial data suggested antacids were superior, this was due to detecting minor bleeding, not clinically significant events.
Area of Science:
- Gastroenterology
- Critical Care Medicine
- Pharmacology
Background:
- Stress ulcer bleeding is a significant concern in critically ill patients.
- Previous studies suggested varying efficacy between antacids and cimetidine for prevention.
Purpose of the Study:
- To compare the efficacy of antacids versus cimetidine in preventing stress ulcer bleeding.
- To clarify the impact of diagnostic methods on reported bleeding rates.
Main Methods:
- Meta-analysis of 16 prospective trials involving 2133 patients.
- Categorization of bleeding events based on diagnostic criteria (occult blood vs. overt bleeding).
Main Results:
- No significant difference in preventing overt bleeding between antacids (3.3%) and cimetidine (2.7%).
- Both antacids and cimetidine were significantly more effective than placebo (15%) in preventing overt bleeding.
- Initial suggestions of antacid superiority were attributed to detection of clinically insignificant bleeding.
Conclusions:
- Antacids and cimetidine demonstrate comparable efficacy in preventing clinically significant stress ulcer bleeding.
- Diagnostic methodology is crucial for accurate assessment of stress ulcer bleeding prevention.
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