Summary

Stress ulcer prophylaxis (SUP) aims to prevent gastrointestinal bleeding in critically ill patients at high risk, such as those on mechanical ventilation for over 48 hours or with coagulopathy. Current guidelines recommend SUP with proton pump inhibitors or H2-receptor antagonists. Key trials show these agents reduce clinically significant bleeding versus placebo, with proton pump inhibitors potentially more effective than H2-receptor antagonists. However, no mortality benefit has been demonstrated. When prescribing SUP, providers should assess bleeding risk daily and discontinue prophylaxis promptly when risk factors resolve to minimize adverse effects. The decision to provide SUP involves weighing benefits versus potential harms for each patient.