Agents demonstrated to have an efficacy of greater than 90% for prophylactic treatment of stress ulceration include which of the following?

a. Antacids

b. H2 receptor antagonists

c. Sucralfate

The hourly administration of antacid (30 to 60 mL) by nasogastric tube, maintaining the gastric luminal fluid at pH above 3.5, has proven to be effective prophylaxis. In a study of 100 seriously ill patients who were randomly assigned to receive placebo or antacid prophylaxis, bleeding was detected in 25% of patients given no prophylaxis, compared to 4% of patients given antacids through the nasogastric tube. In a review of data derived from 16 prospective trials, when overt bleeding manifested by melena, hematemesis, or transfusion requirement was used as the minimum criterion, there was no significant difference in risk of bleeding, comparing antacids and cimetidine.

Continuous infusions of any of the H2-receptor antagonists provides more consistent maintenance of an intraluminal gastric pH of greater than 3.5 than do the standard intermittent-infusion regimens. Advantages of continuous infusion of these agents include a potential reduction in toxicity, decreased pharmacy costs and nursing duties, and possible enhancement of therapeutic benefit. Controlled trials suggest that sucralfate, 1 g every 6 hours, may be as effective as antacids or cimetidine prophylactically. In 100 critically ill patients, bleeding occurred in 6% of patients receiving antacids or cimetidine, while none of the 34 patients on sucralfate bled.

Given exogenously, natural or synthetic prostaglandins of the E, F, and I series inhibit gastric acid secretion. One group compared the efficacy of 15(R)-15 dimethyl PGE2 given at antisecretory doses to antacids and found that stress-related bleeding occurred in 50% of patients given the synthetic prostaglandin derivative, compared to only 14% of patients receiving antacids.