Introduction

Stress ulcer prophylaxis (SUP) refers to the prevention of stress-related mucosal damage in critically ill patients, which can lead to clinically significant gastrointestinal bleeding. Stress ulcers affect up to 100% of critically ill patients not receiving prophylaxis. Bleeding from stress ulcers is associated with increased mortality. Pharmacists play a key role in identifying patients at risk, selecting appropriate prophylactic agents, and regularly reassessing the need for continued prophylaxis. Recent guidelines recommend SUP only for high-risk patients rather than universally providing prophylaxis to all ICU patients. Controversy exists regarding the optimal agent for prophylaxis and the risk of complications like pneumonia and Clostridium difficile infection. This section will cover the epidemiology, pathophysiology, risk factors, and pharmacologic management of stress ulcer prophylaxis.