A new gastric assay was employed to screen for the ulcerogenic activity of non-steroid anti-inflammatory (NSAI) analgesic drugs. The technique involves exposing rats to brief periods of cold stress, which is not itself sufficient to cause mucosal damage, but does specifically sensitize the stomach to irritant or ulcerogenic actions of NSAI drugs. The assessment of gastric ulcerogenicity of some well-known anti-inflammatory/analgesic drugs using this new assay was shown to agree well with clinical reports of the occurrence of gastric ulceration and haemorrhage. This assay was employed to screen for the ulcrogenicity of some new anti-inflammatory drugs and for potential drug interactions resulting from administration of certain frequently used combinations of these drugs.

The comparative gastric ulcerogenic activities of non-steroid anti-inflammatory drugs.

Introduction
A number of issues concerning stress ulcer prophylaxis remain unresolved despite numerous randomized, controlled trials and several meta-analyses. The role of stress ulcer prophylaxis, particularly in trauma patients, is further complicated by the lack of trials utilizing clinically important bleeding as an endpoint. Given the lack of consensus regarding stress ulcer prophylaxis in trauma patients, prescribing practices at Level I trauma centers in the United States were assessed.

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Stress ulcer prophylaxis in trauma patients

https://www.amjmed.com/article/0002-9343(87)90808-4/pdf

Therapeutic goals and treatment options for prevention of stress ulcer syndrome

In patients in a surgical intensive care unit a controlled clinical trial was performed concerned with the pathophysiological functions of histamine in stress ulcer disease and with the influence of cimetidine prophylaxis on this complication. The commonly used organization of a controlled clinical trial was enforced to be changed by considerable theoretical, ethical and practical difficulties in designing and conducting the study:
 As a surprising and remarkable result of the study clinically manifest stress ulcers occurred exclusively in our patients in the intensive care unit and among them mainly in those with severy polytrauma and postoperative complications. Cimetidine was highly effective in preventing stress ulceration in severe polytrauma patients. But it seems absolutely unnecessary to distribute this drug in all patients of a surgical intensive care unit like from a cornucopia of happiness.

/pdf/histamine-and-stress-ulcer-new-components-in-organizing-a-8k56anp4vz.pdf

Histamine and stress ulcer: New components in organizing a sequential trial on cimetidine prophylaxis in seriously Ill patients and definition of a special group at risk (severe polytrauma)

Stress ulcer syndrome refers to gastroduodenal erosions or ulcers that develop acutely in relation to major physi ological stress, usually manifested clinically as upper gastrointestinal (UGI) bleeding. These lesions occur most often in the gastric fundus. Endoscopy has shown gastroduodenal mucosal lesions in 75 to 100% of inten sive care unit (ICU) patients within 72 hours of admis sion. Patients at high risk for stress ulcer include those with large body surface area burns, intracranial lesions associated with coma, fulminant hepatic failure, sepsis, and trauma and abdominal, cardiovascular, and thoracic surgery patients. Also considered high risk are ICU pa tients with superimposed complications such as shock, mechanical ventilation for more than 3 days, coagulopa thy, jaundice, and sepsis. Approximately 15% of ICU pa tients will experience UGI bleeding from stress ulcer. Patients bleeding from stress ulcer have an overall mor tality rate approaching 65% compared with 9 to 22% mortality in patients wit...

Bowen Jc

Papers

A prospective study of stress ulceration in Vietnam.