What are the effectiveness and harms of interventions to prevent upper gastrointestinal bleeding (UGIB) in patients admitted to the intensive care unit (ICU)?

Despite advancements in medical treatments and interventions, UGIB results in more than 300 000 hospital admissions annually in the United States and has a mortality rate of 3.5% to 14%.1,2  Upper gastrointestinal bleeding is frequently the result of stress ulcers—superficial damage of the mucosal lining of the stomach or intestines that can occur as the result of shock, sepsis, or trauma. With improvements in treatment options and standards of care, the incidence of UGIB in ICUs has been decreasing,3  yet stress ulcer prophylaxis is still commonplace. Because there are potential risks associated with stress ulcer prevention, this practice needs to be examined.

The disadvantage of stress ulcer prophylaxis is that many of the interventions used to suppress gastric acid can alter the gastric...

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