Document Detail


Evidence-based medicine as it applies to acid suppression in the hospitalized patient.
MedLine Citation:
PMID:  12072665     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
An evidence-based-medicine approach may be applied to studies in the medical literature to help physicians make sound judgments about efficacy and safety data and to improve clinical decision making. To assess the role of gastric acid suppression in the prevention of stress ulcer bleeding and in the management of upper gastrointestinal bleeding after successful hemostasis of bleeding peptic ulcer disease, the following questions should be addressed: Is it possible to identify risk factors for clinically important bleeding in critically ill patients? Can intravenous acid suppression prevent stress ulcer-related bleeding or prevent rebleeding in peptic ulcers after successful hemostasis? What is the most effective method of acid suppression for these disorders? An evidence-based-medicine review of published trials yields sufficient evidence to support the use of prophylactic acid suppression in critically ill patients with coagulopathy or in those who are receiving prolonged mechanical ventilation. Not enough data have accumulated to prove the superiority of intravenous proton pump inhibitors to intravenous histamine-2-receptor antagonists for prophylaxis of clinically important stress ulcer bleeding. With respect to acute gastrointestinal bleeding, however, two well-conducted trials indicate that an intravenous proton pump inhibitor is significantly more effective than an intravenous histamine-2-receptor antagonist or placebo in reducing the rate of rebleeding after hemostasis in patients with bleeding peptic ulcer. Analysis of the data from both trials shows that only five to six patients would need to receive an intravenous proton pump inhibitor to avoid one episode of rebleeding.
Authors:
Brooks D Cash
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Critical care medicine     Volume:  30     ISSN:  0090-3493     ISO Abbreviation:  Crit. Care Med.     Publication Date:  2002 Jun 
Date Detail:
Created Date:  2002-06-19     Completed Date:  2002-07-23     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0355501     Medline TA:  Crit Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  S373-8     Citation Subset:  AIM; IM    
Affiliation:
Gastroenterology Division, Naval Hospital Camp Lejeune, Camp Lejeune, NC, USA.
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MeSH Terms
Descriptor/Qualifier:
Antacids / therapeutic use*
Clinical Trials as Topic
Decision Making
Evidence-Based Medicine*
Health Knowledge, Attitudes, Practice
Hospitalization*
Humans
Peptic Ulcer Hemorrhage / drug therapy,  epidemiology,  prevention & control
Treatment Outcome
Chemical
Reg. No./Substance:
0/Antacids

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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