Acid Suppressive Therapy for Stress Ulcer Prophylaxis in Noncritically Ill Patients

Purpose: Stress ulcer prophylaxis (SUP) is routinely administered to critically ill patients for the prevention of stress ulcer–induced, clinically important bleeding (CIB). Recently, the value of SUP has been questioned due to the perceived decline in CIB and the potential for infectious complications secondary to acid suppressive therapy. The SUP-ICU trial is a large, randomized controlled trial comparing intravenous pantoprazole with placebo for the indication of SUP. It is hoped that this trial would answer many of the questions pertaining to the overall value of SUP. This article will provide an in-depth assessment of the SUP-ICU trial in the context of the overall body of literature in this area. Furthermore, applications for clinical practice and recommendations on the provision of SUP are provided. Summary: The SUP-ICU trial revealed no difference in the primary outcome of 90-day mortality with pantoprazole but lower rates of CIB were noted (which was a secondary outcome). Overall, these data provide important insight into the value of SUP along with other questions related to the provision of SUP such as the relationship between CIB and mortality, infectious complications, and enteral nutrition. Conclusions: The SUP-ICU trial is a landmark trial describing the value of SUP in a modern-day setting of intensive care unit (ICU) practice. The provision of SUP should be continued in high-risk patients. Future studies are ongoing that will add further insight to this routine practice.

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Evaluation of Continuation of Stress Ulcer Prophylaxis at Hospital Discharge

Hospital Pharmacy ◽

10.1310/hpj4410-888 ◽

2009 ◽

Vol 44 (10) ◽

pp. 888-893 ◽

Cited By ~ 6

Author(s):

William R. Judd ◽

George A. Davis ◽

P. Shane Winstead ◽

Douglas T. Steinke ◽

Timothy M. Clifford ◽

...

Keyword(s):

Health Care ◽

Adverse Events ◽

Hospital Admission ◽

Drug Interactions ◽

Stress Ulcer ◽

Inappropriate Prescribing ◽

Health Care Expenditures ◽

Stress Ulcer Prophylaxis ◽

Suppressive Therapy ◽

Ulcer Prophylaxis

Purpose Stress-related mucosal disease (SRMD) can adversely affect patient morbidity and mortality. The use of stress ulcer prophylaxis (SUP) in patients with no risk factors for clinically important bleeding, however, is contributing to health care-related adverse events, drug interactions, and costs. The objective was to determine the percentage of hospitalized patients who receive SUP without an approved indication and to evaluate the financial impact of inappropriate prescribing as well as the risk for significant drug-drug interactions. Methods A retrospective chart review was performed of hospitalized adult cardiology, family medicine, and internal medicine patients between July 1, 2006 and June 30, 2007. Prescribing of acid suppressive therapy (AST) during hospital admission and indications for SUP were evaluated. Concomitant medications, cost of therapy, and discharge medications were assessed as secondary outcomes. Results Of the 4,603 patients admitted during the study period, 418 were randomly selected for study inclusion. Approximately 53% (221/418) of the selected patients received SUP during hospital admission, 93% (206/221) of whom had no indication for prophylaxis. Of those who continued AST at discharge (14%; 31/221), 84% (26/31) had no approved indication. Overuse of SUP resulted in 77 potential drug-drug interactions and an estimated 30-day outpatient cost of $37,950 for patients receiving these medications at discharge. Conclusion SUP is frequently prescribed to non–critically ill patients when the risk of SRMD is low. Use of SUP for patients who do not meet evidence-based criteria appears to contribute to increased health care expenditures, potential adverse events, and drug interactions.

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Commentary on “Stress Ulcer Prophylaxis in Hospitalized Patients, Subsequent Use in Primary Care and Physicians’ Opinions About Acid-Suppressive Therapy”

Southern Medical Journal ◽

10.14423/smj.0000000000000429 ◽

2016 ◽

Vol 109 (3) ◽

pp. 165-166

Author(s):

Pablo Guisado-Vasco

Keyword(s):

Primary Care ◽

Stress Ulcer ◽

Hospitalized Patients ◽

Stress Ulcer Prophylaxis ◽

Suppressive Therapy ◽

Ulcer Prophylaxis

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Stress Ulcer Prophylaxis in Hospitalized Patients, Subsequent Use in Primary Care, and Physicians’ Opinions About Acid-Suppressive Therapy

Southern Medical Journal ◽

10.14423/smj.0000000000000433 ◽

2016 ◽

Vol 109 (3) ◽

pp. 158-164 ◽

Cited By ~ 1

Author(s):

Muhammad Riaz ◽

Susan Hughes ◽

Ivan A. Gomez ◽

Roger B. Mortimer

Keyword(s):

Primary Care ◽

Stress Ulcer ◽

Hospitalized Patients ◽

Stress Ulcer Prophylaxis ◽

Suppressive Therapy ◽

Ulcer Prophylaxis

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Current practice of stress ulcer prophylaxis in a surgical patient cohort in a German university hospital

Langenbeck s Archives of Surgery ◽

10.1007/s00423-021-02325-3 ◽

2021 ◽

Author(s):

Julia Rauch ◽

Maciej Patrzyk ◽

Claus-Dieter Heidecke ◽

Tobias Schulze

Keyword(s):

Risk Factors ◽

Side Effects ◽

Stress Ulcer ◽

Demographic Data ◽

Stress Ulcer Prophylaxis ◽

University Hospital ◽

Surgical Patients ◽

Suppressive Therapy ◽

Surgical Patient ◽

Ulcer Prophylaxis

Abstract Introduction Stress ulcer prophylaxis (SUP) has been a widespread practice both in intensive care units (ICU) and internal wards at the beginning of the twenty-first century. Clinical data suggests an important overuse of acid suppressive therapy (AST) for this indication. Data on current clinical practice of SUP in surgical patients in a non-ICU setting are spares. In the light of a growing number of reports on serious side effects of AST, this study evaluates the use of AST for SUP in a normal surgical ward in a German university hospital. Methods Between January 2016 and June 2016, SUP was analysed retrospectively in 1132 consecutive patients of the Department of Surgery of the Universitätsmedizin Greifswald. Results The patients managed with and without SUP were similar with respect to demographic data and treatment with anticoagulants, SSRI and glucocorticoids. Patients with SUP were treated more frequently by cyclooxygenase inhibiting drugs (NSAID, COX2-inhibitors), were more frequently treated in the intermediated care unit and had a longer hospital stay. Risk factors for the development of stress ulcers were similarly present in patient groups managed with and without SUP. About 85.7–99.6% of patients were given SUP without an adequate risk for stress ulcer development, depending on the method used for risk assessment. Discussion Still today, SUP is widely overused in non-ICU surgical patients. Information campaigns on risk factors for stress ulcer development and standard operating procedures for SUP are required to limit potential side effects and increased treatment costs.

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