Should prophylaxis against stress ulcer be abandoned for patients in intensive care?

EDITOR—The meta-analysis of Messori et al clearly confirms the lack of usefulness of systematic prophylaxis against stress ulcer with H₂ receptor antagonists or sucralfate,1 but an important issue is left unanswered by this study and by the meta-analysis of Cook et al.2 Indeed, some critically ill patients receive prophylaxis against stress ulcers for specific reasons, including brain injury (trauma, surgery, haemorrhage), steroid treatment, and coagulation abnormalities.

Does the available literature support such prophylaxis for these patients? In other words, should intensivists prescribe stress ulcer prophylaxis for selected subgroups of patients? If the available literature does not resolve this issue, should the further trials suggested by Messori et …