Prospective endoscopic study of stress erosions and ulcers in critically ill adult patients treated with either sucralfate or placebo.

OBJECTIVE

To compare the frequency of stress erosions and ulcers in critically ill adult patients treated with either sucralfate or placebo.

DESIGN

Prospective, randomized study.

SETTING

Intensive care unit in a university hospital.

PATIENTS

Twenty-six adult patients. All patients were mechanically ventilated and were at risk of developing stress ulceration.

INTERVENTIONS

Patients were randomized to receive either sucralfate (2 g every 8 hrs) (group 1) via the nasogastric tube (flushed with 10 mL of sterile water) or 20 mL of sterile water every 8 hrs (group 2) via the nasogastric tube.

MEASUREMENTS AND MAIN RESULTS

At the time of intensive care unit admission, the frequency of stress (acute) erosions (as assessed with the endoscope) was 21.7%. No ulcers were detected. By day 3, the frequency had increased to 37.5% in group 1 and 88.9% in group 2. Mucosal deterioration was more likely in the patients treated with placebo (water) (p < .05). In total, seven patients developed acute ulceration in group 2 compared with only one patient in group 1 (p < .05). The frequency of gastric colonization with aerobic Gram-negative bacilli was 25.6% in group 1 and 28.6% in group 2. Only one retrograde nosocomial pneumonia developed (group 1).

CONCLUSION

Based on our findings, we strongly recommend the adoption of sucralfate as opposed to no prophylaxis in the prevention of acute upper gastrointestinal ulceration.