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.