According to an editorial, the take-home message from this trial is that, given the low incidence of clinically important upper GI bleeding in the ICU, prophylaxis with a PPI, if initiated, should be reserved for seriously ill patients who are at high risk for this complication. It notes that an important problem here is that the definition of a high risk of bleeding varies between guidelines and needs to be standardized. It adds that although 90-day mortality was not affected by pantoprazole, the between-group difference in the rate of important upper GI bleeding may still support the recommendation of using a prophylactic PPI, particularly given the absence of a difference in the rate of adverse events between the pantoprazole group and the placebo group. It calls for more data are to determine the clinical effects of prophylaxis for GI bleeding in the ICU, especially in groups of patients who are at very high risk for this complication, and to quantify any protective or harmful effects attributable to the co-administration of enteral nutrition.