[Pharma clinics. How I diagnose and treat...stress ulcers]

Stress related ulcers are superficial and extensive gastric mucosal lesions. They occur in almost all critically ill patients but lead to gastrointestinal bleedings in only 5 to 10%. Endoscopy permits definitive diagnostic. Stress related mucosal diseases encount for substantial morbidity and mortality. The preventive therapeutic choice depends on efficacy, side effects as cost and nosocomial pneumonia. Sulcralfate appears to be the best choice because of its lower cost, comparable efficacy (sucralfate versus anti-H2) and its lower risk of inducing nosocomial pneumonia. Patients who greatly benefit from prevention, present respiratory failure with at least 48 hours mechanical ventilation, coagulopathy, sepsis or burns. Global management avoiding hypoxia, hypotension and acidosis, takes an important part in the prevention.