Stress ulcer: is routine prophylaxis necessary?

Recent observations have suggested that stress ulcer prophylaxis should not routinely be used to prevent upper gastrointestinal hemorrhage in critically ill patients. This is because our understanding of stress ulcer pathogenesis has shifted from a problem limited to back diffusion of acid to a phenomenon of gastric ischemia. The purpose of this article is to review the proposed mechanism of stress ulcer bleeding and to discuss prophylaxis.