Dr Tryba has posed several questions regarding our article,1 and we will try to address each of them. First, he questioned the completeness of our literature review. We searched peer-reviewed articles and did not think that review articles presented at a sucralfate symposium, which were published in a journal supplement,2 would necessarily be completely objective. He also pointed out that a high percentage of our patients had head injuries and suggested that many patients suffered from aspiration pneumonia. This could be true, but one may expect earlier clinical symptoms with aspiration pneumonia—not as late as 5.6 days after injury as stated in the article. Also, even if aspiration accounted for many pneumonias, the incidence of "nonaspiration pneumonia" should be the same in all three treatment groups since the groups were all well matched.
We agree with Dr Tryba that it is frequently difficult to establish the