Stress-related mucosal disease in the critically ill patient

Prevalence of clinically important stress-ulcer bleeding is low (∼1%), but because of its severity it remains an important issueProphylaxis for stress-ulcer bleeding should be restricted to patients with acknowledged risk factors because of the risk of nosocomial infectionDespite controversies, PPIs seem to be the most clinically effective and cost-effective strategyRandomized clinical trials and observational studies are needed to assess new preventive strategies and to adapt therapeutic management approaches of upper gastrointestinal bleeding to the intensive care unit settingStress-ulcer prophylaxis is being overused; two-thirds of patients without risk-factors receive treatment, two-thirds continue treatment upon transfer from the intensive care unit and one-third are discharged home on treatment without a new indication