BMJ 2001;322:995 ( 21 April )

Letters

Ranitidine and gastrointestinal bleeding in intensive care

    Should prophylaxis against stress ulcer be abandoned for patients in intensive care?
    Occult blood loss is clinically important

Should prophylaxis against stress ulcer be abandoned for patients in intensive care?

The first 150 words of the full text of this article appear below.

EDITOR---The meta-analysis of Messori et al clearly confirms the lack of usefulness of systematic prophylaxis against stress ulcer with H2 receptor antagonists or sucralfate,1 but an important issue is left unanswered by this study and by the meta-analysis of Cook et al.2 Indeed, some critically ill patients receive prophylaxis against stress ulcers for specific reasons, including brain injury (trauma, surgery, haemorrhage), steroid treatment, and coagulation abnormalities.

Does the available literature support such prophylaxis for these patients? In other words, should intensivists prescribe stress ulcer prophylaxis for selected subgroups of patients? If the available literature does not resolve this issue, should the further trials suggested by Messori et al stratify the groups according to the patient's condition?

Jean-Charles Preiser, clinical director. 
Clinique Reine Fabiola, 73 avenue du Centenaire, B6061 Montignies-sur-Sambre, Belgium preiserj@ulb.ac.be


1. Messori A, Trippoli S, Vaiani M, Gorini M, Corrado A. Bleeding and pneumonia in intensive care patients given ranitidine and sucralfate for prevention of stress ulcer: meta-analysis of randomised controlled trials. BMJ 2000; 321: 1103-1106[Abstract/Free Full Text]. (4 November.)
2. Cook D, Reeve BK, Guyatt GH, Heyland DK, Griffith LE, Buckingham L, et al. Stress ulcer prophylaxis in critically ill patients: resolving discordant meta-analyses. JAMA 1996; 275: 308-314[Abstract/Free Full Text].

Occult blood loss is clinically important

EDITOR---Intensive care has always been a difficult area for research.

Firstly, patients are rarely able to give informed consent, which places increased pressure on researchers and ethics committees to ensure . . . [Full text of this article]
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Relevant Article

Bleeding and pneumonia in intensive care patients given ranitidine and sucralfate for prevention of stress ulcer: meta-analysis of randomised controlled trials
A Messori, S Trippoli, M Vaiani, M Gorini, and A Corrado
BMJ 2000 321: 1103. [Abstract] [Full Text] [PDF]

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