Sepsis: a review describes factors associated with stress ulcers and gastrointestinal bleeding

Complications of severe illness, not everyday stress

The stress ulcers studied here concern adults with sepsis or septic shock. The word “stress” refers to physiological strain caused by severe illness, not everyday psychological stress. These findings therefore allow no conclusions about anxiety-related digestive problems.

The abstract presents routine drug prophylaxis as a debated practice, citing the lack of definitive evidence of a mortality benefit and possible adverse effects, including hospital-acquired pneumonia. However, the review addresses factors associated with gastrointestinal complications, rather than directly comparing preventive strategies.

Six studies, with no pooled risk estimate

The researchers searched eight databases through September 1, 2026. They included six observational cohort or case-control studies involving 131,568 adults with sepsis or septic shock. Study selection, data extraction and quality assessment were performed independently by two researchers.

Across the studies, the frequency of stress ulcers or gastrointestinal bleeding ranged from 2.0% to 32.3%. This broad range is not an estimate of individual risk: it brings together populations and events that are not necessarily comparable.

The authors conducted a narrative synthesis rather than a meta-analysis because there were too few studies for each association. The abstract provides neither follow-up durations nor numerical estimates for each association.

Which profiles were associated with complications?

Recurring indicators included coagulation disorders, shock, mechanical ventilation, liver and kidney dysfunction, illness severity and a history of gastrointestinal bleeding. Other associations included age, immunosuppression and certain treatments.

These observations do not demonstrate that each factor causes bleeding. For example, mechanical ventilation may also indicate more severe illness. The abstract does not make it possible to check precisely how each study accounted for these overlapping factors.

A way to improve assessment, not a new treatment rule

The authors advocate risk-adapted prevention rather than a uniform approach. Their review describes elements that could help inform this assessment, but validates neither a decision score nor a treatment strategy.

For patients and their loved ones, the message remains about hospital care: gastrointestinal risk is assessed alongside overall health, medical history and treatments. This publication does not justify starting or stopping a stomach-protecting medication.

What we can take away

In sepsis, several patient and illness characteristics are associated with gastrointestinal complications. Further research is needed to demonstrate whether targeted prevention works better than routine prevention.