Ranitidine or sucralfate do not prevent stress ulcer in intensive care patients

Ranitidine and sucralfate are widely used to prevent gastrointestinal bleeding in patients in intensive care. Several recommendations suggest this prophylaxis, but the Food and Drugs Administration (FDA) and the European Medicines Evaluation Agency (EMEA) have not given their approval. The meta-analysis by Messori et al (p 1103) shows that ranitidine does not prevent gastrointestinal bleeding, and data for sucralfate are insufficient to conclude anything on its effectiveness. Ranitidine was found to increase the risk of pneumonia under certain circumstances. Further trials are needed, but their design poses the problem of whether placebo can be given to control groups.