Stress ulcers and ulcer peptic disease in critically ill patients

Stress ulcers and peptic ulcer disease remain significant complications among critically ill patients hospitalized in intensive care units, primarily due to their association with clinically significant upper gastrointestinal bleeding. Although advances in critical care management have reduced their incidence, prevention remains a priority. Stress ulcers originate from splanchnic hypoperfusion, ischemia-reperfusion and a systemic inflammatory response, which compromises the defense mechanisms of the gastrointestinal mucosa. They differ from peptic ulcer disease in their acute onset, diffuse nature, and direct relationship with the severity of the critical illness, although both conditions can coexist. Clinically, bleeding is classified as occult, overt, and clinically significant. Currently, the incidence of clinically significant bleeding ranges from 1% to 4%, concentrated in patients with major risk factors such as prolonged mechanical ventilation, coagulopathy, sepsis, shock, multiple organ dysfunction, liver or kidney disease, severe neurological injury, and the use of ulcerogenic drugs. Early enteral nutrition has a partial protective effect, but it does not replace pharmacological prophylaxis. Evidence shows that prophylaxis significantly reduces clinically significant bleeding, without impacting overall mortality or increasing infections. Current guidelines recommend an individualized approach, based on risk stratification and timely discontinuation of treatment when predisposing factors disappear.