Do not prescribe “gastroprotection” for stress ulcer prophylaxis in medical patients unless there is a high risk of bleeding.

Do not prescribe “gastroprotection” for stress ulcer prophylaxis in medical patients unless there is a high risk of bleeding.

Type of practice

Drugs

Age

Adult, Geriatric

Topic Area

Hospital Internal Medicine

According to international guidelines, the prophylaxis of peptic stress ulcers with antisecretive drugs, represented by H2 receptor antagonists and proton pump inhibitors, is not routinely indicated for the “medical” patient, unless it is related to patients admitted to intensive care or at high risk of bleeding. The term “gastroprotection” is indeed inappropriate, hiding the possible negative effects linked to the prolonged use of proton pump inhibitors, such as Clostridioides difficile colitis, pneumonia, bone fractures, chronic renal failure, interference with platelet function, vitamin B12 deficiency, alterations of the intestinal microbiota. Furthermore, it has been observed that the administration of these drugs during hospitalization tends to continue after discharge, with significant negative effects on patients’ health and leading to higher costs for National Health System.

Sources

1. Clarke K, Adler N, Agrawal D, et al. Indications for the use of proton pump inhibitors for stress ulcer prophylaxis and peptic ulcer bleeding in hospitalized patients. Am J Med 2022; 135:313-7. doi:10.1016/j.amjmed.2021.09.010.
2. Heidelbaugh JJ, Goldberg KL, Inadomi JM. Adverse risks associated with proton pump inhibitors: a systematic review. Gastroenterol Hepatol 2009; 5:725-34. PMID: 37967443; PMCID: PMC2886361.
3. Herzig SJ, Howell MD, Ngo LH, et al. Acid-suppressive medication use and the risk for hospital-acquired pneumonia. JAMA 2009; 301:2120–8. doi: 10.1001/jama.2009.722.
4. Imhann F, Bonder MJ, Vich Vila A, et al. Proton pump inhibitors affect the gut microbiome. Gut 2016; 65:740–8. doi: 10.1136/gutjnl-2015-310376.
5. Osservatorio Nazionale sull’impiego dei Medicinali. L’uso dei farmaci in Italia. Rapporto Nazionale 2022. Roma: Agenzia Italiana del Farmaco; 2023. p. 501-8.

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Attention. Please note that these items are provided only for information and are not intended as a substitute for consultation with a clinician. Patients with any specific questions about the items on this list or their individual situation should consult their clinician.