Prophylaxis of gastrointestinal tract bleeding in patients admitted to a general hospital ward. Comparative study of sucralfate and cimetidine.

Gastrointestinal bleeding prophylaxis is well known in patients admitted to intensive care units, but only a few reports have analyzed this problem in patients admitted to a general hospital ward. In a previous study we demonstrated that close to 20% of such seriously ill placebo-treated patients bled. We conducted a prospective, randomized trial comparing cimetidine in a single dose of 800 mg and sucralfate at a dose of 1g/6h in a group of 139 patients from a cohort of 2010 patients consecutively admitted during a 10-month period to a department of internal medicine at a teaching hospital. The severity of their illness was assessed by the simplified acute physiologic score (SAPS). Gastrointestinal bleeding was assessed at the beginning of the study and daily during the hospitalization by means of Hemoccult paper tests or when frank hematemesis or melena occurred. Two of the 71 patients assigned to cimetidine and 2 of the 68 assigned to sucralfate presented with acute gastrointestinal bleeding, which was more severe in the sucralfate group. The drugs had similar safety profiles and were well tolerated, but the easier administration of cimetidine in a single dose, together with its low cost (25% less than sucralfate) argues in favor of cimetidine to prevent gastrointestinal bleeding in seriously ill patients admitted to general hospital wards.