Do we still need pharmacological stress ulcer prophylaxis at the ICU?

The gastric mucosa is vulnerable in critically ill patients. The term stress-related mucosal disease describes the common mucosal damage in the gastrointestinal tract ranging from small single lesions to multiple gastric ulcers and major bleeding complications in intensive care patients. The underlying pathophysiology comprises hemodynamic and inflammatory elements. Systemic factors (hypotension and/or vasopressor therapy) act together with local alterations of splanchnic blood flow, e.g., due to high ventilation pressures. This may not only cause direct ischemic damage but also leads to a reduction in gastric mucosal defense by inhibition of cyclooxygenase or lipoxygenase pathways and decline of prostaglandin levels (especially PGE2) (1).