Which pharmacologic prevention of stress ulcers is commonly used in the ICU?

• A. Proton pump inhibitors (e.g., pantoprazole) or H2 blockers (e.g., ranitidine); PPIs preferred
• B. Antacids
• C. Sucralfate
• D. Steroids

Answer: (C)

In critically ill patients, preventing stress-related mucosal disease focuses on reducing gastric acidity to protect the stomach lining. The most commonly used pharmacologic approach in the ICU is acid-suppressive therapy with a proton pump inhibitor or an H2 receptor blocker, with PPIs generally preferred because they provide more potent and consistent acid suppression and have strong support from evidence showing reduced incidence of GI bleeding in at-risk patients. Examples include pantoprazole or another PPI, and ranitidine or other H2 blockers.

Sucralfate forms a protective coating over the mucosa, but it doesn’t decrease acid production and is less effective at preventing stress ulcer bleeding; it also requires more frequent dosing and has less supporting evidence for ICU-wide prophylaxis. Antacids neutralize acid temporarily but do not offer reliable mucosal protection or consistent prevention of bleeding, and steroids do not prevent stress ulcers and may increase GI bleeding risk.