Consider pharmacologic stress ulcer prophylaxis for critically ill patients with additional risk factors for gastrointestinal bleeding (Weak recommendation).

Common indications for prophylaxis include risk factors such as coagulopathy, mechanical ventilation for > 48 hours (particularly without enteral nutrition), history of chronic liver disease, sepsis, shock, and/or acute kidney injury among others.

Patients receiving enteral nutrition may not need additional prophylaxis and the role of medication is unclear in this population.

Enteral nutrition is thought to reduce the risk of stress ulcers through a variety of gut protective mechanisms, and early enteral nutrition is now a common part of many modern intensive care unit approaches.

Pharmacologic stress ulcer prophylaxis does not appear to reduce the risk of gastrointestinal bleeding or mortality in critically ill patients receiving enteral nutrition (including those receiving mechanical ventilation), but may increase the risk of hospital-acquired pneumonia.

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