SUCRALFATE VERSUS ANTACIDS OR HISTAMINE2 (H2) RECEPTOR ANTAGONISTS FOR STRESS ULCER BLEEDING PROPHYLAXIS

BACKGROUND: Histamine2 (H2)-receptor antagonists and antacids have been the mainstay pharmacologic agents for the prevention of stress ulcers and incumbent ulcer bleeding in hospital in-patients during the past decade. Recently, drugs without major influence on gastric pH have been investigated in stress bleeding prophylaxis, with one being sucralfate. OBJECTIVE: To study the efficacy of sucralfate in the prevention of macroscopically visible stress bleeding, in comparison to Histamine2 (H2)-receptor antagonists and antacids. METHODOLOGY: This prospective cohort was conducted upon a sample of 400 patients (aged 18 and above) admitted to the Dept. of Medicine & Allied at Abbasi Shaheed Hospital, Karachi from January 2018 to December 2018. No gender bias was observed and all patients were chosen via multistage sampling (with enrollment carried out on the basis of non-probability consecutive sampling and pharmacologic agent allotment done on the basis of simple random sampling. Data was recorded onto a structured questionnaire containing inquiries about the study variables, inferences obtained from clinical examination notes and details of all morbidity and mortality during hospitalization. The data obtained was analyzed using SPSS v.21 & Microsoft Excel 2016. RESULTS: We observed that there is a trend toward decreased overt bleeding when either of the pharmacologic agents are compared with no therapy. Histamine2 receptor antagonists and antacids are associated with a trend toward lower clinically important bleeding rates than sucralfate. However, sucralfate does outperform the other two pharmacologic agents in terms of limiting undesirable outcomes. CONCLUSION: After careful consideration, it can be concluded that histamine2 receptor antagonists and antacids have a higher efficacy in preventing stress ulcer bleeding than sucralfate. However, given the added benefits of sucralfate and its cumulative effect on reducing eventual arte of mortality among inpatients, its use should be considered in conjunction with either histamine2 receptor antagonists and antacids, with the use of histamine2 receptor antagonists recommended owing to the fact that it is most efficacious and prophylaxis with this pharmacologic agent decreases the incidence of overt gastrointestinal bleeding and clinically important bleeding, more than any other tested drug