Changing perspectives of H2 antagonists for stress ulcer prophylaxis

Bleeding from stress-related mucosal damage is a feared complication in critically ill patients. For the past 20 years antacids, and then H2 antagonists, have been the mainstays for protecting patients from stress bleeding. Recent evidence, however, questions the need for such therapy for most intensive care unit patients. Furthermore, increasing the intragastric pH may predispose patients to the development of nosocomial pneumonias, which carries a greater risk of mortality than does bleeding from stress ulcers. In patients who require gastric protection, sucralfate, which has no effect on gastric pH, is the preferred choice.