Neurocritical Care

, Volume 29, Issue 3, pp 344–357 | Cite as

Stress Ulcer Prophylaxis in Neurocritical Care

  • Jeffrey F. Barletta
  • Alicia J. Mangram
  • Joseph F. Sucher
  • Victor Zach
Review Article


Stress ulcer prophylaxis (SUP) with acid-suppressive drug therapy is widely utilized in critically ill patients following neurologic injury for the prevention of clinically important stress-related gastrointestinal bleeding (CIB). Data supporting SUP, however, largely originates from studies conducted during an era where practices were vastly different than what is considered routine by today’s standard. This is particularly true in neurocritical care patients. In fact, the routine provision of SUP has been challenged due to an increasing prevalence of adverse drug events with acid-suppressive therapy and the perception that CIB rates are sparse. This narrative review will discuss current controversies with SUP as they apply to neurocritical care patients. Specifically, the pathophysiology, prevalence, and risk factors for CIB along with the comparative efficacy, safety, and cost-effectiveness of acid-suppressive therapy will be described.


Stress ulcer prophylaxis Acid-suppressive therapy Proton pump inhibitors Histamine-2-receptor antagonists Gastrointestinal hemorrhage Adverse drug events Neurocritical care 


Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflicts of interest.


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Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  • Jeffrey F. Barletta
    • 1
  • Alicia J. Mangram
    • 2
  • Joseph F. Sucher
    • 2
  • Victor Zach
    • 3
  1. 1.Midwestern University, College of Pharmacy-GlendaleGlendaleUSA
  2. 2.Honor Health- John C. Lincoln Medical CenterPhoenixUSA
  3. 3.Honor HealthA.T. Still University School of Osteopathic MedicinePhoenixUSA

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