Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 May 26:17511437251338614.
doi: 10.1177/17511437251338614. Online ahead of print.

Stress ulcer prophylaxis practice in UK critical care units: A comparison of cross-sectional surveys between 2020 and 2024

Mark Borthwick  1 , Greg Barton  2 , Emma Boxall  3 , John P Dade  4 , Odran Farrell  5 , Ruth Forrest  6 , Emma Graham-Clarke  7 , David Kean  8 , Helen Leigh  9 , Reena Mehta  10 , Gillian Mulherron  11 , Ruth Roadley-Battin  12 , David Sapsford  13 , Alan Timmins  14 , John Warburton  15 , Richard S Bourne  16   17
Affiliations

Stress ulcer prophylaxis practice in UK critical care units: A comparison of cross-sectional surveys between 2020 and 2024

Mark Borthwick et al. J Intensive Care Soc. .

Abstract

Background: Critically ill patients are at risk of bleeding from stress ulcers. Comprehensive information regarding United Kingdom stress ulcer prophylaxis (SUP) practices are not available and may change over time. We aimed to describe SUP practices in 2020 and reevaluate the position in 2024.

Methods: Critical care pharmacists provided observed SUP practice data for UK adult critical care units via an electronic repository in 2020 and 2024. One response was accepted from each critical care unit at each time point. Data collected included trigger criteria for commencing SUP, primary medication class used, primary SUP cessation criteria, and level of nutritional intake (if part of cessation criteria).

Results: There were high response rates of 70.3% (2020) and 66.7% (2024) of registered UK adult critical care units. Few differences in primary SUP trigger criteria between 2020 and 2024 were seen, with small differences in the categories of 'SUP not used' (p = 0.002) and 'Shock' (p = 0.027) driving statistical significance (χ2(7, 454) = 16.76, p = 0.019). There was a significant change in the primary medication class used for SUP (H2 receptor antagonist 49.4% 2020, vs 0.4% 2024, proton pump inhibitor 44.7% 2020 vs 97.8% 2024; χ2(2, 458) = 159.62, p < 0.001). Primary SUP cessation criteria was 'Patient fed' (66.8% 2020, 64.6% 2024), with most describing this threshold as met when the patient receives full enteral feed (72.0% 2020, 78.8% 2024).

Conclusion: The UK has moved towards proton pump inhibitors as the primary SUP medication class. SUP is most frequently discontinued on establishment of enteral nutrition.

Keywords: Peptic ulcer; critical illness; enteral nutrition; histamine H2 antagonists; proton pump inhibitors.

PubMed Disclaimer

Conflict of interest statement

Greg Barton MBE receives funding for his role as an Editor-in-Chief for Critical Illness (Pharmaceutical Press). Dr Richard Bourne is funded by a National Institute for Health and Care Research (NIHR) Senior Clinical and Practitioner Research Award (NIHR304524). The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the National Institute for Health and Care Research or the Department of Health and Social Care. All other authors have declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Primary trigger for commencing pharmacological stress ulcer prophylaxis in UK adult critical care units. Dark blue: 2020 cohort (n = 235). Light blue: 2024 cohort (n = 226). χ2(7, 454) = 16.76, p = 0.019 (null returns excluded). Adjusted residuals were significant for ‘SUP not used’, p = 0.002, and ‘Shock’, p = 0.027.
Figure 2.
Figure 2.
Primary medication class used for stress ulcer prophylaxis in UK adult critical care units. Dark blue: 2020 cohort (n = 235). Light blue: 2024 cohort (n = 226). χ2(2, 458) = 159.62, p < 0.001 (null returns excluded). Adjusted residuals were significant for ‘H2 Receptor Antagonist’, p < 0.001, ‘Proton Pump Inhibitor’, p < 0.001, and ‘No SUP’, p = 0.022.
Figure 3.
Figure 3.
Primary criteria used for ceasing stress ulcer prophylaxis in UK adult critical care units. Dark blue: 2020 cohort (n = 235). Light blue: 2024 cohort (n = 226). χ2(5, 461) = 17.81, p = 0.003. Adjusted residuals were significant for ‘SUP never started’, p = 0.002, and ‘Other’, p = 0.003.
Figure 4.
Figure 4.
‘Patient fed’ criteria used for ceasing stress ulcer prophylaxis in UK adult critical care units. Dark blue: 2020 cohort (n = 157). Light blue: 2024 cohort (n = 146). χ2(2, 303) = 1.87, p = 0.392.
See this image and copyright information in PMC

References

    1. Cook D, Heyland D, Griffith L, et al.. Risk factors for clinically important upper gastrointestinal bleeding in patients requiring mechanical ventilation. Crit Care Med 1999; 27: 2812–2817. - PubMed
    1. Evans L, Rhodes A, Alhazzani W, et al.. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021. Intensive Care Med 2021; 47: 1974–1247. - PMC - PubMed
    1. MacLaren R, Dionne JC, Granholm A, et al.. Society of Critical Care Medicine and American Society of Health-System Pharmacists guideline for the prevention of stress-related gastrointestinal bleeding in critically ill adults. Crit Care Med 2024; 52: e421–e430. - PubMed
    1. Cook DJ, Witt LG, Cook RJ, et al.. Stress ulcer prophylaxis in the critically III: a meta-analysis. Am J Med 1991; 91: 519–527. - PubMed
    1. Cook D, Guyatt G. Prophylaxis against upper gastrointestinal bleeding in hospitalized patients. N Engl J Med 2018; 378: 2506–2516. - PubMed

LinkOut - more resources