Stress Ulcer Prophylaxis
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QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Ahmed Saeed Mohamed Ibrahim ◽  
Sameh Salem Hefni Taha ◽  
Samuel Habachi Daniel ◽  
Emil Noshy Aziz Salh

Abstract Background Sfress Ulceration was an important cause of morbidity and mortality in critically ill patients. Early active treatment reduces the risk of clinically significant bleeding, ulcer prophylaxis therefore became a standard of care in all critically ill patients. Objective The overall aims of the Stress ulcer prophylaxis in the critically ill patients is to determine the benefits and risks of stress ulcer prophylaxis stress ulcer prophylaxis (SUP) in intensive care unit Materials and Methods We performed this systematic review and meta-analysis according to the recommendations of the Meta-analysis of Observational Studies in Epidemiology (MOOSE) statement and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. In the our systematic review and meta-analysis, we searched Medline via PubMed, CENTRAL, Web of Science, SCOPUS, and Google Scholar from March 1977 till August 2019. The search retrieved 2289 unique records. We then obtained 237 final results for full-text screening. At last, 28 recorded studies were involved in our in the present study. Results 23 included studies reported the rates of clinically important GI bleeding. The overall effect estimates favored SUP over control for decreasing the hazards of clinically significant GI hemorrhage (P value <0.001, OR— 0.55, CI of 95%[0.35 0.86]). The overall effect estimates did not favor SUP over control for reducing the rate of death (P value =0.24, OR 1.21, 95% CI [0.87 — 1.69]). 23 studies reported the rates of pneumonia. The overall effect estimates showed that the SUP was not related to elevated hazards of nosocomial pneumonia over control (P value —0.15, OR —1.5, CI of 95% [0.83 3.02]). The analysis showed that only Cimetidine 900 mg was effective in reducing the incidence of clinically important GI bleeding (OR 0.45 [0.24, 0.82], p *0.009). In contrary, none of the included PPIs (pantoprazole, lansoprazole, omeprazole), ranitidine, or sucralfate were effective in reducing the incidence of clinically important GI bleeding. Conclusion SUP is associated with lower risk of GI bleeding in critically ill patients; however, the current published literature shows significant inconsistency. Our analysis showed that, no significant difference between H2RA and PPI in term of incidence of clinically important GI bleeding, H2RAs (mainly cimetidine) more effective than other classes of SUP which significantly reduced the risk of overt GI hemorrhage, and none of the drug classes was effective in reducing the mortality rates.

2021 ◽  
Vol 11 (1) ◽  
Myung Jin Song ◽  
Seok Kim ◽  
Dachung Boo ◽  
Changhyun Park ◽  
Sooyoung Yoo ◽  

AbstractProton pump inhibitors (PPIs), followed by histamine 2 receptor antagonists (H2RAs), are the most commonly used drugs to prevent gastrointestinal bleeding in critically ill patients through stress ulcer prophylaxis. The relative efficacy and drug-related adverse events of PPIs and H2RAs remain unclear. In this retrospective, observational, comparative cohort study, PPIs and H2RAs for stress ulcer prophylaxis in critically ill patients were compared using a common data model. After propensity matching, 935 patients from each treatment group (PPI or H2RA) were selected. The PPI group had a significantly higher 90-day mortality than the H2RA group (relative risk: 1.28; P = 0.01). However, no significant inter-group differences in the risk of clinically important gastrointestinal bleeding were observed. Moreover, there were no significant differences between the groups concerning the risk of pneumonia or Clostridioides difficile infection, which are known potential adverse events related to these drugs. Subgroup analysis of patients with high disease severity were consistent with those of the total propensity score-matched population. These findings do not support the current recommendations, which prefer PPIs for gastrointestinal bleeding prophylaxis in the intensive care unit.

Julia Rauch ◽  
Maciej Patrzyk ◽  
Claus-Dieter Heidecke ◽  
Tobias Schulze

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.

2021 ◽  
Vol 32 (4) ◽  
pp. 645-649
Dhani Wijaya ◽  
Suharjono ◽  
Fendy Matulatan ◽  
Elfri Padolo

Abstract Objectives The World Health Organization (WHO) estimated that more than 50% of drugs were prescribed incorrectly, including stress ulcer prophylaxis (SUP) drugs. Prescribing SUP drugs in incorrect doses and frequencies are considered irrational, and may affects to the effectivity of the therapy. This research aimed to assess the appropriateness of the SUP drugs regimentation in the inpatient surgery room at Dr. Soetomo Hospital, Surabaya, Indonesia. Methods This research was cross-sectional study and conducted for 4 weeks in 2019 in the inpatient surgery room of Dr. Soetomo Hospital. The population was SUP drugs that were prescribed in inpatient surgery room. Those SUP drugs with indications for the prevention of stress-induced ulcers that complied to the terms listed on the American Society of Health-System Pharmacists (ASHP) were included as the samples, and vice versa. The samples then assessed for their regimentation appropriateness using the dose and frequency standard of ASHP. Results There were 224 dose units taken as sample, from the total population of 1,404 SUP drugs. The result showed that as much as 48.2% of SUP medications were given to the patients in inappropriate regimentation. Of that number, all ranitidine injection were inappropriately regimented. On the contrary all omeprazole injection dose units were appropriately regimented, meanwhile the amount of appropriate regimentation of sucralfate suspension were 74.6%. Conclusions According to ASHP standard, the SUP drugs in the inpatient surgery room at Dr. Soetomo Hospital were mostly given in inappropriate regimentation. Further research is needed to explore how will those inappropriate regimentation affect on the efficacy of therapy in the patients.

Karen Clarke ◽  
Nicole Adler ◽  
Dimpal Bhakta ◽  
Suchita Shah Sata ◽  
Sarguni Singh ◽  

Proton pump inhibitors (PPIs) are among the most commonly used medications in the world; however, these drugs carry the risk of patient harm, including acute and chronic kidney disease, Clostridium difficile infection, hypomagnesemia, and fractures. In the hospital setting, PPIs are overused for stress ulcer prophylaxis and gastrointestinal bleeding, and PPI use often continues after discharge. Numerous multifaceted interventions have demonstrated safe and effective reduction of PPI use in the inpatient setting. This narrative review and the resulting implementation guide summarize published interventions to reduce inappropriate PPI use and provide a strategy for quality improvement teams.

2021 ◽  
Vol 49 (6) ◽  
pp. 030006052110251
Minqiang Huang ◽  
Ming Han ◽  
Wei Han ◽  
Lei Kuang

Objective We aimed to compare the efficacy and risks of proton pump inhibitor (PPI) versus histamine-2 receptor blocker (H2B) use for stress ulcer prophylaxis (SUP) in critically ill patients with sepsis and risk factors for gastrointestinal bleeding (GIB). Methods In this retrospective cohort study, we used the Medical Information Mart for Intensive Care III Clinical Database to identify critically ill adult patients with sepsis who had at least one risk factor for GIB and received either an H2B or PPI for ≥48 hours. Propensity score matching (PSM) was conducted to balance baseline characteristics. The primary outcome was in-hospital mortality. Results After 1:1 PSM, 1056 patients were included in the H2B and PPI groups. The PPI group had higher in-hospital mortality (23.8% vs. 17.5%), GIB (8.9% vs. 1.6%), and pneumonia (49.6% vs. 41.6%) rates than the H2B group. After adjusting for risk factors of GIB and pneumonia, PPI use was associated with a 1.28-times increased risk of in-hospital mortality, 5.89-times increased risk of GIB, and 1.32-times increased risk of pneumonia. Conclusions Among critically ill adult patients with sepsis at risk for GIB, SUP with PPIs was associated with higher in-hospital mortality and higher risk of GIB and pneumonia than H2Bs.

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