Background: Critically ill patients with moderate-to-severe physiologically stressful event are at high risk of developing stress ulcers. The use of pharmacological prophylaxis significantly reduces the incidence of stress ulcer in high-risk patients.
Objective: The aim of this study was to assess the use of pharmacological prophylaxis for stress ulcer in the medical wards of University of Gondar Hospital.
Methods: A cross-sectional study design was used. In total, 234 patients were selected through simple random sampling technique. The risk of stress ulcer development was assessed using Evidence-Based Medicine Guideline for stress ulcer prepared by Orlando Regional Medical Center. SPSS version 21 was used for data analysis.
Result: The most common acute risk factor to stress ulcer was coagulopathy (18.4%), followed by hypoperfusion (9.8%). The concomitant non-steroidal anti-inflammatory drug use (16.7%), mild-to-moderate brain or spinal cord injury (11.1%), and concomitant or recent corticosteroid use (9.4%) were frequently seen risk factors that necessitate administration of a prophylaxis. In total, 82 (35%) study participants were given stress ulcer prophylaxis, among which 52 (63.4%) were given without indication. The most commonly used drug class in the prevention of stress ulcer was proton pump inhibitors (76/82, 92.7%). In total, 43 (18.4%) study subjects were not given stress ulcer prophylaxis while there was clear indication. Patients with a long hospital stay and a diagnosis of central nervous system disorders had significant risk for inappropriate stress ulcer prophylaxis use.
Conclusion: In this study, inappropriate use of prophylaxis for stress ulcer was common. The higher proportion of inappropriateness was due to the use of stress ulcer prophylaxis while there was no enough indication. We recommend future researchers to assess the cost and impact of inappropriate stress ulcer prophylaxis use, and the physicians should be adherent to the standard guidelines.
Keywords: Inappropriate; proton pump inhibitors; stress ulcer prophylaxis.
Conflict of interest statement
Declaration of conflicting interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Stress Ulcer Prophylaxis With a Proton Pump Inhibitor Versus Placebo in Critically Ill Patients (SUP-ICU Trial): Study Protocol for a Randomised Controlled TrialM Krag et al. Trials 17 (1), 205. PMID 27093939. - Randomized Controlled TrialThe SUP-ICU trial will provide high-quality data on the benefits and harms of stress ulcer prophylaxis with a proton pump inhibitor in critically ill adult patients admit …
Evaluation of Adherence to American Society of Health-System Pharmacists Guidelines: Stress Ulcer Prophylaxis in Shiraz, IranSM Masoompour et al. Gastroenterol Nurs 40 (6), 491-495. PMID 29210818.Overuse of stress ulcer prophylaxis has a considerable cost burden on patient and healthcare systems. This study aimed to determine the adherence level of stress ulcer pr …
Stress Ulcer Prophylaxis in Hospitalized Patients Not in Intensive Care UnitsRR Grube et al. Am J Health Syst Pharm 64 (13), 1396-400. PMID 17592004. - ReviewAST is commonly misused in hospitals, with as many as 71% of patients in general medicine wards receiving some sort of AST without an appropriate indication. Anticoagulan …
Overuse of Proton Pump Inhibitors for Stress Ulcer Prophylaxis in JordanMA Alqudah et al. Int J Clin Pharmacol Ther 54 (8), 597-602. PMID 27125772.The high frequency of inappropriate PPI prescriptions in stress ulcer prophylaxis for inpatients is a major issue in Jordan. Following the current recommended therapeutic …
Stress Ulcer ProphylaxisJF Barletta et al. Crit Care Med 44 (7), 1395-405. PMID 27163192. - ReviewMany stress ulcer prophylaxis recommendations are based on older studies at risk of bias, which may not be applicable to modern practice. Stress ulcer prophylaxis should …
- Heidelbaugh JJ, Inadomi JM. Magnitude and economic impact of inappropriate use of stress ulcer prophylaxis in non-ICU hospitalized patients. Am J Gastroenterol 2006; 101(10): 2200–2205. - PubMed
- Rumbaugh K, Cole K, May A. VUMC multidisciplinary surgical critical care service: gastrointestinal stress ulcer prophylaxis guidelines. 2013, https://www.vumc.org/trauma-and-scc/files/trauma-and-scc/public_files/Manual/Gastrointestinal%20Stress%20Ulcer%20Prophylaxis%20Guidelines.pdf
- Cook DJ, Fuller HD, Guyatt GH, et al. Risk factors for gastrointestinal bleeding in critically ill patients. New Engl J Med 1994; 330(6): 377–381. - PubMed
- Dellinger RP, Levy MM, Rhodes A, et al. Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012. Crit Care Med 2013; 41(2): 580–637. - PubMed
- Eisa N, Bazerbachi F, Alraiyes AH, et al. Q: do all hospitalized patients need stress ulcer prophylaxis? Cleve Clin J Med 2014; 81(1): 23–25. - PubMed