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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 — not shown for this use

The product information we hold does not support a dose for this page's specific use, route or population, so none is shown. Follow your local or national guideline, and confirm against the product SmPC.

The licensed dosing — for the medicine's licensed uses, which may differ from this page's — is on Esomeprazole.

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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