Sucralfate pp 289-301 | Cite as

Sucralfate for Prevention of Acute Gastrointestinal Bleeding

  • Robert S. Bresalier


Patients admitted to critical care units (ICUs) develop a spectrum of gastroduodenal mucosal lesions related to severe physiologic stress. Stress-related gastrointestinal bleeding from such lesions has been reported in 8 to 33% of patients admitted to ICUs who do not receive prophylactic therapy, but the incidence of severe or clinically significant bleeding is less than 6% and appears to have decreased during the past decade. Routine prophylaxis against stress-related bleeding is commonplace in ICUs worldwide, represen- ting a substantial cost to patients and use of resources. Sucralfate, primarily in suspension form, has been used extensively as prophylaxis against acute upper gastrointestinal hemorrhage in critically ill patients. This chapter will review the rationale for such therapy, and compare its efficacy with other types of treatment. Other uses of sucralfate for prevention of gastrointestinal bleeding will also be briefly discussed.


Nosocomial Pneumonia Coffee Ground Stress Ulcer Prophylaxis Overt Bleeding Acute Gastrointestinal Bleeding 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


The Pathophysiology of Stress-Related Gastrointestinal Bleeding

  1. 1.
    Bresalier RS: The clinical significance and pathophysiology of stress-related gastric mucosal hemorrhage. J Clin Gastroenerol 13(suppl 2):S35–S43, 1991. Detailed review of the clinical significance and pathophysiology of stress-related mucosal damage. Includes 100 references.Google Scholar
  2. 2.
    Silen W: Experimental models of gastric ulceration and injury. Am J Physiol 255:6395–6402, 1988. Critical review of animal models of stress-induced ulceration.Google Scholar
  3. 3.
    Schiessel R, Feil W, Wenzl E: Mechanisms of stress ulceration and implications for treatment. Gastroenterol Clin North Am 19:101–120, 1990. Review of potential mechanisms of gastroduodenal damage related to physiologic stress, and their implications for treatment. Includes 65 references.PubMedGoogle Scholar
  4. 4.
    Konturek PK, Brzoozowski T, Konturek S, et al:Role of epidermal growth factor, prostaglandin and sulfhydryls in stress-induced gastric lesions. Gastroenterology 99:1607–1615, 1990. Suggests a newly recognized role for epidermal growth factor in protection against stress-induced gastric injury.PubMedGoogle Scholar

Prevention of Acute GI Bleeding

  1. 5.
    Czaja MA, McAlhany JC, Pruitt BA: Acute gastroduodenal disease after thermal injury. An endoscopic evaluation of incidence and natural history. N Engt J Med 291:925–929, 1974. Early article describing the endoscopically monitored evolution of stress-related lesions in critically ill patients.CrossRefGoogle Scholar
  2. 6.
    Schuster DP, Rowley H, Feinstein S, et al: Prospective evaluation of the risk of upper gastrointestinal bleeding after admission to a medical intensive care unit. Am J Med 76:623–630, 1984. Examines the risk of stress-related bleeding in patients not receiving medical prophylaxis. Suggests a low incidence of clinically significant bleeding. Emphasizes importance of prolonged mechanical ventilation and coagulopathy as risk factors.PubMedCrossRefGoogle Scholar
  3. 7.
    Hastings PR, Skillman JJ, Bushnell LS, et al: Antacid titration in the prevention of acute gastrointestinal bleeding. N Engl J Med 298:1041–1045,1978. Early series that popularized antacid prophylaxis against stress-related bleeding.PubMedCrossRefGoogle Scholar
  4. 8.
    Zinner MJ, Zuidema GD, Smith PL, et al: The prevention of upper gastrointestinal tract bleeding in an intensive care unit. Surg Gynecol Obstet 153:214–220, 1981. Largest and best early series comparing the efficacy of prophylaxis against stress-related bleeding with antacids and bolus i.v. H2RAs. Includes a notreatment control group.PubMedGoogle Scholar
  5. 9.
    Schuman RB, Schuster DP, Zuckerman GR: Prophylactic therapy for stress ulcer bleeding: A reappraisal. Ann Intern Med 106:562–567, 1987. Review emphasizes the need to define the source and magnitude of bleeding in evaluating efficacy of stress ulcer prophylaxis.Google Scholar
  6. 10.
    Martin LF, Booth FVM, Karlstadt RG, et al: Continuous intravenous cimetidine infusion decreases stress-related upper gastrointestinal hemorrhage without promoting pneumonia. Crit Care Med 21:19–30, 1993. Multicenter placebo-controlled study of continuous i.v. cimetidine for prophylaxis of stress-related bleeding. Accompanying editorial: Schuster DP: Stress ulcer prophylaxis: In whom? With what? Crit Care Med 21:4–6,1993. Points out important flaws in this and other existing studies of stress ulcer prophylaxis, and need for better study design.PubMedCrossRefGoogle Scholar
  7. 11.
    Cook DJ, Witt LG, Cook RJ: Stress ulcer prophylaxis in the critically ill: A meta analysis. Am J Med 519–527, 1991.Google Scholar
  8. 12.
    Tryba M: Prophylaxis of stress ulcer bleeding. A meta analysis. J Clin Gastroenterol 13(suppl 2):544–555, 1991. Two recent meta-analyses compare the efficacy of antacids, H2RAs, and sucralfate for prevention of stress-related bleeding. Analysis by Cook examines effect on both “overt” and “clinically important” bleeding. Review by Tryba uses “macroscopic bleeding” as criterion for analysis.Google Scholar
  9. 13.
    Cook DJ, Laine LA, Guyatt GH, et al: Nosocomial pneumonia and the role of gastric pH. A meta-analysis. Chest 100:7–13, 1991. Meta-analysis examining the differential effect of agents used for stress-bleeding prophylaxis on nosocomial pneumonia in critically ill patients.PubMedCrossRefGoogle Scholar

Copyright information

© Plenum Press 1995

Authors and Affiliations

  • Robert S. Bresalier
    • 1
  1. 1.Departments of Medicine, Henry Ford Health Sciences CenterUniversity of Michigan School of MedicineDetroit

Personalised recommendations