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Proton Pump Inhibitor — Stress Ulcer Prophylaxis

Esomeprazole (Burns — Curling's Ulcer Prophylaxis)

Brand names: Nexium

Esomeprazole is a proton pump inhibitor used for stress ulcer (Curling's ulcer) prophylaxis in critically ill burns patients to prevent upper gastrointestinal bleeding from gastric stress mucosal damage.

Dosing — being independently re-sourced

ClinCalc Pro is rebuilding its dose data from primary open sources — the manufacturer SmPC (eMC), the WHO Model Formulary and other official references — under clinician review. This drug's structured dose is not yet published here. Confirm all doses against the product SmPC and your local formulary before prescribing.

Clinical monograph

How it works

It irreversibly inhibits the gastric H+/K+-ATPase proton pump in parietal cells, markedly reducing acid secretion and raising intragastric pH.

Prescribing in practice

  • Stress ulcer prophylaxis should be reserved for patients with genuine risk factors and reviewed regularly, as acid suppression is associated with increased risk of nosocomial pneumonia and Clostridioides difficile infection.
  • Prolonged use is linked to hypomagnesaemia and reduced absorption of some nutrients.
  • It is a CYP2C19 inhibitor and can raise exposure to some co-administered drugs, including reducing the activation of clopidogrel.

Monitoring

Monitor for gastrointestinal bleeding, the ongoing indication for prophylaxis, and magnesium on prolonged therapy.

Counselling the patient

  • This medicine protects the stomach lining from stress-related ulcers during critical illness.
  • It should be reviewed and stopped once the higher-risk period has passed.

Evidence & guidelines

Stress ulcer prophylaxis with acid suppression is recommended for critically ill patients with bleeding risk factors, with use balanced against infection risks.

Reference: NICE NG17 (Acutely ill adults — GI bleeding prevention); BBA Major Burns Guidelines; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. Monograph status: clinician-reviewed (2026-07-04).

Related

Curated clinical cross-links plus same-class fallbacks.

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