Among critically ill patients in the intensive care unit (ICU), complications are frequent, including stress ulcers in the upper gastrointestinal tract. To help prevent the development of ulcers, antagonism of gastric acid (with antacids historically) or inhibition of the production of acid (with histamine-2 receptor blockers more recently) were implemented as part of routine critical care. The introduction of proton pump inhibitors, with data demonstrating improved ulcer prevention and recovery compared with histamine-2 receptor blockers in non–critically ill patients, led many physicians who provide care for critically ill patients to incorporate proton pump inhibitors for routine stress ulcer prophylaxis.¹ However, the lack of randomized clinical trials (RCTs) that directly compared histamine-2 receptor blockers with proton pump inhibitors for stress ulcer prophylaxis in critically ill patients, combined with decreasing incidence of significant gastrointestinal bleeding in these patients and emerging evidence of an association between proton pump inhibitor use and adverse events, including Clostridioides difficile (Clostridium difficile) infection,² cognitive decline,³ and nosocomial pneumonia,⁴ made the optimal choice of routine stress ulcer prophylaxis less clear.

在重症监护病房（ICU）的重症患者中，并发症频发，包括上消化道应激性溃疡。为了帮助预防溃疡的发展，作为常规重症监护的一部分，实施了对胃酸的拮抗作用（历史上与抗酸药结合）或抑制酸的产生（最近对组胺2受体阻滞剂）。质子泵抑制剂的引入，与非组危患者相比，组胺2受体阻滞剂具有更好的溃疡预防和恢复数据，促使许多为重症患者提供护理的医生将质子泵抑制剂纳入常规预防应激性溃疡的治疗。^1个然而，缺乏将组胺2受体阻滞剂与质子泵抑制剂直接比较用于危重病患者应激性溃疡预防的随机临床试验（RCT）缺乏，以及这些患者发生重大胃肠道出血的发生率下降，以及新出现的证据表明质子泵抑制剂的使用和不良事件，包括艰难梭菌（Clostridium difficile）感染，²认知功能下降，³和医院内肺炎，⁴使得预防常规应激性溃疡的最佳选择不清楚。