Potential Uses of Intravenous Proton Pump Inhibitors to Control Gastric Acid Secretion

Metz, David C.

doi:10.1159/000007798

Cited by 29 publications

(23 citation statements)

References 49 publications

(71 reference statements)

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“…1 However, oral PPIs may be inadequate to obtain desired therapeutic outcomes in the treatment of acid-related disorders (e.g., in cases of non-variceal upper gastrointestinal bleeding (UGB), Zollinger-Ellison Syndrome). 2 In order to obtain better treatment efficacy, physicians generally prescribe parenteral PPIs in place of oral PPIs or oral H 2 -Ras.…”

Section: Introductionmentioning

confidence: 99%

Prospective Assessment of Prescribing Pattern of Intravenous Proton Pump Inhibitors in an Indian Tertiary-Care Teaching Hospital

Churi¹,

Jogani²

2015

IJOPP

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Context: Inappropriate use of intravenous proton pump inhibitors (IV PPIs) has been a major challenge for private health-care setups. Inappropriate prescribing may result in increased shortages of IV PPIs in hospitals, therapeutic burden, adverse effects, and treatment costs. Therefore, the study was sought to determine drug utilization patterns (appropriateness and inappropriateness) of IV PPIs in an Indian tertiary-care teaching hospital. Aims: To assess the drug utilization pattern of IV PPIs in a tertiary-care teaching hospital. Settings and Design: This was a prospective observational study. Methods and Material: This study was conducted over a period of one month. Patients who were ≥18 years of age, who were admitted in the internal medicine, surgery, or gastroenterology wards, and who were receiving IV PPIs were included in the study. Paediatric patients and outpatients were not enrolled in the study. Ddemographics, past medication and surgery, current medical condition and medication, dose, dosing interval, duration of therapy, length of stay, and endoscopic details of each patient was collected from patients' case notes, treatment charts, and laboratory/diagnostic test reports, and evaluated for appropriateness regarding indication. Statistical analysis: Chi square test (χ 2 ) was used to analyze the data. Results: Prospective assessment involved 611 patients over a 1-month period. For prophylaxis (stress ulcer, pre-operative and postoperative prophylaxis) and treatment, IV PPIs were prescribed inappropriately to 289 (89.2%) internal medicine and 97 (34.04%) surgery ward patients. Prolonged therapy was found in patients who received IV PPIs for stress ulcer prophylaxis. Conclusion: This study revealed significant inappropriateness of PPI administration with particular reference to indication to use, duration of therapy, and changeover of therapy in an Indian tertiary-care teaching hospital.

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Section: Introductionmentioning

confidence: 99%

Prospective Assessment of Prescribing Pattern of Intravenous Proton Pump Inhibitors in an Indian Tertiary-Care Teaching Hospital

Churi¹,

Jogani²

2015

IJOPP

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“…SRMD is apparent in 75–100% of critically ill patients within 24 hours of admission to an intensive care unit (ICU) [1,2]. Clinically important bleeding, defined as macroscopic bleeding resulting in hemodynamic instability or the need for red blood cell transfusion, occurs as a result of SRMD in about 3.5% of ICU patients who are mechanically ventilated for 48 hours or more [3].…”

Section: Stress Ulcer Prophylaxis In Critically Ill Patientsmentioning

confidence: 99%

“…The most common adverse effects associated with H 2 RAs include headaches, dizziness, diarrhoea, nausea and constipation [1]. More rarely, H 2 RAs can also cause serious adverse effects such as thrombocytopenia [33], changes in liver function, and interstitial nephritis [34].…”

Section: The Limitations Of Current Therapiesmentioning

confidence: 99%

Untitled

Brett

2004

Crit Care

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45GI = gastrointestinal; H 2 RAs = histamine H2 receptor antagonists; ICU = intensive care unit; IV = intravenous; PPIs = proton pump inhibitors; SRMD = stress-related mucosal damage.Available online http://ccforum.com/content/9/1/45 Stress ulcer prophylaxis in critically ill patientsStress-related mucosal damage (SRMD) is an erosive gastritis of unclear pathophysiology, which can occur rapidly after a severe insult such as trauma, surgery, sepsis or burns. SRMD is apparent in 75-100% of critically ill patients within 24 hours of admission to an intensive care unit (ICU) [1,2]. Clinically important bleeding, defined as macroscopic bleeding resulting in hemodynamic instability or the need for red blood cell transfusion, occurs as a result of SRMD in about 3.5% of ICU patients who are mechanically ventilated for 48 hours or more [3]. Along with mechanical ventilation, risk factors for clinically important bleeding from SRMD include coagulopathy, shock, severe burns, a history of gastrointestinal (GI) ulceration, and multiple organ failure [4,5]. Bleeding is associated with a 20-30% increase in absolute risk of mortality, and with an increase of 1-4 in relative risk [3]. In addition, it increases the demand on limited blood stocks and extends the length of ICU stay by about 4-8 days [3], thereby adding to overall management costs.To avert these consequences, prophylaxis has been recommended for all ICU patients at high risk of SRMD [4,5]. Stress ulcer prophylaxis is included in the care bundle for critically ill patients on mechanical ventilation recommended by the Institute for Healthcare Improvement and adopted by the National Health Service Modernization agency in the UK [6]. The Surviving Sepsis Campaign, an international initiative founded by the European Society of Intensive Care Medicine, the Society of Critical Care Medicine and the International Sepsis Forum, has also recommended that prophylaxis be a part of critical care [7]. Specific risk factors for SRMD include: mechanical ventilation (more than 48 hours), coagulopathy, neurosurgery, any kind of shock, respiratory AbstractProphylaxis is routinely provided for critically ill patients admitted to intensive care units (ICUs) who are at high risk for stress-related mucosal damage (SRMD), an erosive process of the gastroduodenum associated with abnormally high physiological demands. Traditionally, treatment options have included sucralfate, antacids and histamine H2 receptor antagonists (H 2 RAs). The H 2 RAs are currently the most widely used agents in prophylactic acid suppression; however, proton pump inhibitors (PPIs) have recently replaced H 2 RAs in the treatment of many acid-related conditions. PPIs achieve a more rapid and sustained increase in gastric pH and are not associated with the rapid tachyphylaxis seen with H 2 RAs. As a result, and after the introduction of intravenous formulations, PPIs are beginning to be used for the prophylaxis of SRMD in critically ill adults. The high prevalence of renal and hepatic impairment among the ICU populat...

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“…Proton-pump-inhibitors (PPIs) are the most effective agents for reducing gastric acid secretion, being frequently used in many gastrointestinal disorders [7,8]. Nevertheless, evidence of their benefit in the prophylaxis of bleeding from stress-related mucosal disease is lacking.…”

Section: Introductionmentioning

confidence: 99%

Stress-related mucosal disease: Incidence of bleeding and the role of omeprazole in its prophylaxis

Amaral

Favas

Alves

et al. 2010

European Journal of Internal Medicine

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Background: Upper gastrointestinal bleeding is the severe complication of stress-related mucosal disease in hospitalized patients. In intensive care units (ICU), risk factors are well defined and only mechanical ventilation and coagulopathy proved to be relevant for significant bleeding. On the contrary, in non-ICU settings there is no consensus about this issue. Nevertheless, omeprazole is still widely used in prophylaxis of bleeding. The objective of our study was to evaluate the relevance of stress-related mucosal disease bleeding in patients admitted to an internal medicine ward, and the role of omeprazole in its prophylaxis. Methods: We conducted a retrospective study in which we analysed consecutive patients who were admitted to our ward over a year. We recorded demographic characteristics of the patients, potential risk factors for stress-related mucosal disease (clinical data, laboratory, and medication), administration of prophylactic omeprazole, and total cost of this prophylaxis. Patients with active gastrointestinal bleeding on the admission were excluded. We recorded every upper gastrointestinal bleeding event with clinical relevance. Results: Five hundred and thirty-five patients, mean age 70 years, mean length of stay 9.6 ± 7.7 days; 140 (26.2%) patients were treated with 40 mg of omeprazole intravenously, 193 (36.1%) with 20 mg of omeprazole orally, and 202 (37.8%) patients had no prophylaxis. There was only one episode (0.2%) of clinically relevant bleeding. Conclusion: In patients admitted to an internal medicine ward, incidence of upper gastrointestinal bleeding as a complication of stress-related mucosal disease is low. We found that there is no advantage in prophylaxis with omeprazole.

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Potential Uses of Intravenous Proton Pump Inhibitors to Control Gastric Acid Secretion

Cited by 29 publications

References 49 publications

Prospective Assessment of Prescribing Pattern of Intravenous Proton Pump Inhibitors in an Indian Tertiary-Care Teaching Hospital

Prospective Assessment of Prescribing Pattern of Intravenous Proton Pump Inhibitors in an Indian Tertiary-Care Teaching Hospital

Untitled

Stress-related mucosal disease: Incidence of bleeding and the role of omeprazole in its prophylaxis

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