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Centre for Evidence-
Based Medicine

UGI Bleed: Ranitidine reduces the risk compared to sucralfate

Clinical Bottom Line

In mechanically ventilated patients, the use of ranitidine compared with sucralfate reduces the risk of upper gastrointestinal bleeding.


Cook D, Guyatt G, Marshall J, et al. A comparison of sucralfate and ranitidine for the prevention of upper gastrointestinal bleeding in patients requiring mechanical ventilation.
NEJM 1998;338:791-7

Clinical Question

In mechanically ventilated patients, does the use of ranitidine compared to sucralfate reduce the risk of upper gastrointestinal bleeding.

Search Terms

upper gastrointestinal bleed and ranitidine

The Study

  • Double-blinded, concealed randomisation, controlled trial with intention to treat analysis. Mechanically ventilated medical and surgical patients.
  • Control group (Sucralfate) N= 604, 604 analysed. Control group received ranitidine placebo. Neither group had Gastric pH checked.
  • Experimental group (Ranitidine) N= 596, 596 analysed. Experimental group received sucralfate placebo.

The Evidence

Outcome Time to Outcome CER EER RRR ARR NNT
UGI bleed In hospital 3.8% 1.7% 55% 2.1% 47
95% CI 78% - 8% 4% - 0.3% 25 - 333
Vent associate Pneumonia In hospital 16.2% 19.1% 18% increase 2.9% increase 34 additional pneumonias
95% CI 8% decrease to 51% increase 1.4% decrease to 7.2% increase 72 fewer to 14 additional


Study population in included both medical and surgical adult mechanically ventilated patients.

Appraised By

Pronovost 1999

Expiry Date