Critically ill patients are at increased risk for bleeding in the upper part of the gastrointestinal tract (UGIB) from stress ulcers. Risk factors for the development of bleeding include mechanical ventilation for more than 48 hours and coagulopathy.11,22 Mechanisms that lead to bleeding are often multi-factorial but include splanchnic vasoconstriction and hypoperfusion with altered mucosal blood flow, acid back-diffusion with reduction of bicarbonate secretion, and changes in gastrointestinal motility.33,44 The rate of clinically significant bleeding is low, although when such bleeding occurs, it is associated with prolonged stay in the intensive care unit, increased costs, and mortality.55 

A variety of agents have been used to prevent stress ulcers, including antacids, barrier protection agents, histamine2 receptor antagonists (H2RAs), and proton pump inhibitors (PPIs). The effectiveness...

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