Enteral esomeprazole and intravenous pantoprazole for stress ulcer prophylaxis in critically ill burn patients: An exploratory retrospective study

• Clinically significant gastrointestinal bleeding was infrequent in burn patients. • No difference in bleeding was observed between enteral esomeprazole and IV pantoprazole. • IV pantoprazole use was associated with greater baseline severity and higher mortality. • In less severe patients, enteral esomeprazole was a safe prophylactic option. • The enteral strategy was associated with lower mean cost per patient. Severely burned patients are at increased risk for stress-related mucosal injury and gastrointestinal bleeding. Proton pump inhibitors (PPIs) are widely used for stress ulcer prophylaxis; however, evidence comparing different agents and routes of administration in burn populations remains limited. This retrospective observational study was conducted in a burn intensive care unit and included adult patients hospitalized for more than 72 h. Patients receiving enteral esomeprazole or intravenous pantoprazole for stress ulcer prophylaxis were evaluated. The primary outcome was the occurrence of clinically significant gastrointestinal bleeding, and secondary analyses included baseline clinical severity, hospital mortality, and treatment-related costs. A total of 174 patients were included. The overall incidence of clinically significant gastrointestinal bleeding was 2.3%, with no statistically significant difference between groups. Patients receiving intravenous pantoprazole presented with greater baseline clinical severity, including higher total body surface area burned, longer ICU length of stay, and higher mortality. Economic analysis demonstrated higher treatment-related costs in the intravenous pantoprazole group. In this cohort, enteral esomeprazole was not associated with an increased risk of gastrointestinal bleeding and was associated with lower costs in patients with lower clinical severity and a viable enteral route. These findings should be interpreted as exploratory, given baseline differences between groups.