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Invited Critique
February 2010

Potential Perils of Seemingly Harmless DrugsComment on

Arch Surg. 2010;145(2):147. doi:10.1001/archsurg.2009.259

St. Peter and his colleagues at Children's Mercy Hospital in Kansas City, Missouri, have reported a fascinating post hoc analysis of the potentially detrimental effects of the use of histamine receptor antagonists in children with perforated appendicitis. Many of us lived through the days of stress gastritis and the resultant surgical dogma of “ulcer prophylaxis” through the routine use of postoperative prophylactic H2 receptor antagonists to suppress acid production (and thereby prevent stress gastritis) in patients after major operative procedures. This policy has thankfully been revisited lately, not only because of costs, but also because stress gastritis is almost (if not totally) nonexistent after abdominal or thoracic surgery in our current era (it may remain a problem after head trauma and burns, because these patients are known to be at increased risk for stress ulceration). Indeed, in the last 24 years, one of us (M.G.S.) has attended our weekly Morbidity and Mortality Conference at the Mayo Clinic and can remember only 2 cases of “postop gastritis,” one about 22 years ago (and, yes, it required a near total gastrectomy) and one more than 10 years ago—at that time, an unheard-of entity to the residents. Thus, we no longer use routine “acid suppression” postoperatively after most operations (or at least we hope we don’t). In fact, recent data would suggest that routine use of acid-suppressing agents may even place our patients at risk for Clostridium difficile infection and its complications.

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