Which of the following measures are effective in preventing stress gastritis bleeding in critically ill patients?

A. Improving systemic circulation by correcting any shocklike state resulting from blood loss or sepsis.

B. Correcting systemic acid-base abnormality.

C. Maintaining adequate nutrition.

D. Reducing intragastric acidity by either antacid titration or H 2 antagonists.

DISCUSSION: Despite the lack of documentation, a strong impression exists among clinicians and clinical investigators that the incidence and prevalence of stress gastritis have decreased significantly during the past decade, perhaps owing to improved general care for critically ill patients. The improvement in general care of these critically ill patients includes vigorous efforts to correct any shocklike state secondary to blood loss or sepsis, better ventilatory support, and maintenance of adequate nutrition. These prophylactic measures enhance the ability of the gastric mucosa to protect itself against acid injury. In addition, several prospective, randomized studies have shown that antacid titration and/or H 2-receptor antagonists are effective in preventing gastrointestinal bleeding in these patients.