Prophylaxis against Upper Gastrointestinal Bleeding in Hospitalized Patients

Cook, Deborah J.; Guyatt, Gordon

doi:10.1056/nejmra1605507

Cited by 108 publications

(102 citation statements)

References 68 publications

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“…Intravenous cimetidine injection, however, is the only Food and Drug Administration (FDA) approved medication for prevention of GI bleeding, and other agents are prescribed as off‐label use according to guidelines . The first SUP guidelines, published by American Society of Health‐system Pharmacists (ASHP) in 1999, strongly recommend H2RAs as part of a prophylactic regimen in patients with high risk for stress ulcer‐induced bleeding . Recently, the prescribing trends have shifted towards PPIs based on the study results demonstrating superior efficacy of PPIs to H2RAs in decreasing bleeding occasions as well as inhibiting acid secretions .…”

Section: Discussionmentioning

confidence: 99%

“…The first SUP guidelines, published by American Society of Health‐system Pharmacists (ASHP) in 1999, strongly recommend H2RAs as part of a prophylactic regimen in patients with high risk for stress ulcer‐induced bleeding . Recently, the prescribing trends have shifted towards PPIs based on the study results demonstrating superior efficacy of PPIs to H2RAs in decreasing bleeding occasions as well as inhibiting acid secretions . Nevertheless, H2RAs are more frequently used over PPIs for SUP in our institution due to institution‐specific clinical practices and insurance‐related issues.…”

Section: Discussionmentioning

confidence: 99%

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Impact of a multidisciplinary quality improvement initiative to reduce inappropriate usage of stress ulcer prophylaxis in hospitalized patients

Choi

Sim

Jung

et al. 2020

Brit J Clinical Pharma

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Aims:To promote effective methods to improve overutilization patterns of acidsuppressive therapy in hospitalized patients and to evaluate the impact of multidisciplinary team efforts to reduce inappropriate use of stress ulcer prophylaxis in low-risk patients. Methods:A multidisciplinary quality improvement initiative incorporating education, medication use reviews and reconciliation, and pharmaceutical intervention was implemented in June 2018 for surgical patients hospitalized via emergency department. For the pre-post analysis and time series analysis, patients admitted during April and May were classified into the pre-intervention cohort and those admitted during July and August into the post-intervention cohort.Results: Three hundred and seventeen patients were included in this study (153 and 164 in the pre-and post-intervention cohorts, respectively). The multidisciplinary program was effective in reducing overuse of stress ulcer prophylaxis and healthcare expenses associated with it. Biweekly education on risk factors warranting stress ulcer prophylaxis was provided for clinicians, and acid-suppressive therapy was removed from a preset list of admission orders. The incidence of inappropriate prophylaxis use declined substantially following intervention in overall patients (OR = 0.51, P = 0.01) and a significant decrease was primarily observed among non-ICU patients (OR = 0.50, P = 0.01). Interrupted time series analysis confirmed the significant decline in inappropriate use post intervention (coefficient = −0.63, P < 0.001). The total healthcare expenses associated with such overuse decreased by 58.5% from US$ 19.39 to US$ 8.04 per 100 patient-days. Conclusions:Our multidisciplinary team efforts were associated with improvement in stress ulcer prophylaxis overuse patterns, resulting in a substantial decrease in the incidence of inappropriate use, especially in general wards, and associated healthcare costs. K E Y W O R D Sacid suppression, multidisciplinary, quality improvement, stress ulcer prophylaxis Principal Investigator Statement: The authors confirm that the Principal Investigator for this paper is Sooyoung Shin.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Impact of a multidisciplinary quality improvement initiative to reduce inappropriate usage of stress ulcer prophylaxis in hospitalized patients

Choi

Sim

Jung

et al. 2020

Brit J Clinical Pharma

View full text Add to dashboard Cite

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“…Upon increasing casuarinin dosage, the gastric acidity is decreased due to an increase in the mucin content, as well as a marked inhibition of gastric oxidative stress and inflammation in comparison with the lower doses of casuarinin. This effect is really crucial for the protection of gastric mucosa because mucus represents the first line of defense against injurious factors [2,4,27]. These protective effects of casuarinin were attributed to its stimulant effect on PGE2 production, which protects gastric mucosa by promoting gastric mucus and bicarbonate secretion, along with improving blood flow [28,29].…”

Section: Discussionmentioning

confidence: 99%

“…It was reported that the lifetime prevalence of this disease in the general population is about 5-10 %, an incidence of 0.1-0.3 % per year [1]. Gastric ulcer pathophysiology is complicated and the disease arises from the imbalance between some injurious and defensive factors [2]. Injurious factors include excessive alcohol intake, elevated gastric acid secretion, infection by gram-negative microaerophilic bacteria, and the prolonged use of anti-inflammatory and analgesic medications [3,4].…”

Section: Introductionmentioning

confidence: 99%

Protective Role of Casuarinin from Melaleuca leucadendra against Ethanol-Induced Gastric Ulcer in Rats

et al. 2019

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Gastric ulcer is a major health problem. Current treatment options of gastric ulcer, including antagonists of histamine H2 receptor and inhibitors of the proton pump, do not cure gastric ulcers, but only provide temporary relief of symptoms and can be associated with severe side effects. The lack of effective and safe medications for this global health problem urges for the discovery of novel classes of compounds with potent activity and an acceptable safety profile. Ethanol-induced ulceration in rats was used to evaluate the gastroprotective activity of casuarinin, an ellagitannin isolated from Melaleuca leucadendra. Casuarinin (25, 50, and 100 mg/kg) reduced the ulcer area by 45, 78, and 99%, respectively, compared with the ulcer group. Casuarinin (100 mg/kg) increased mucin content by 1.8-fold and reduced acidity by 42%. At the same dose, it also increased the levels of reduced glutathione by 194%, catalase by 586%, and prostaglandin E2 to its normal level. In contrast, it attenuated the ethanol-increased levels of malondialdehyde by 56%, TNF-α by 58%, and caspase-3 by 87%. Histological findings demonstrated that casuarinin exhibited a protective effect against tissue alterations in response to the ethanol-induced ulcer. Casuarinin suppressed the immunoexpression of nuclear factor-kappa B, cyclooxygenase-2, and inducible nitric oxide synthase to their normal values. It also induced the expression of heat shock protein-70, reaching up to 4.9-fold in comparison with the ulcer group. The potent gastroprotective effect of casuarinin was thus attributed to its anti-inflammatory, antioxidant, and antiapoptotic effects. Our results suggest the potential application of casuarinin as an antiulcer agent from natural sources.

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“…B. dyspeptische Beschwerden) zunehmend allgemein gebräuchlich (common use) geworden ist [4]. Dies ist insofern von großer Relevanz, da sich mit zunehmender Evidenz zeigt, dass eine PPI-Therapie häufiger als bisher angenommen mit Nebenwirkungen oder unerwünschten Ereignissen assoziiert ist [5]. Insbesondere scheint durch die Beeinträchtigung der intestinalen Barrierefunktion ein erhöhtes Risiko für Infektionen, wie nosokomiale Pneumonien oder Clostridium difficile Enteritiden zu bestehen.…”

Section: Introductionunclassified

Einsatz von Protonenpumpenhemmern bei Patienten mit Leberzirrhose – eine Umfrage unter Hepatologen in Deutschland

et al. 2019

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Zusammenfassung Einleitung Protonenpumpeninhibitoren (PPIs) gehören zu den weltweit am häufigsten verordneten Medikamenten. Vor allem bei Patienten mit Leberzirrhose wurden Verschreiberaten von bis zu 78 % berichtet. PPIs scheinen mit relevanten Nebenwirkungen, wie erhöhtem Risiko für nosokomiale Infektionen, spontan bakterieller Peritonitis oder dem Auftreten einer hepatischen Enzephalopathie assoziiert zu sein. Aus diesem Grund war es Ziel dieser Umfrage, die Verschreibungspraxis von PPIs bei Patienten mit Leberzirrhose in Deutschland zu erheben. Methoden Die Daten wurden mittels Web-basierter Befragung erhoben. Hierfür wurde eine Einladung über die Newsletter der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS), des Berufsverbandes Gastroenterologie Deutschland (BVGD) und der Arbeitsgemeinschaft universitärer Gastroenterologen (AUG) versandt. Ergebnisse 61 Personen haben an der Umfrage teilgenommen. Insgesamt wurden sehr hohe PPI-Verschreiberaten von 58 % im stationären, sowie 44 % im ambulanten Bereich berichtet. Beinahe die Hälfte der Befragten gab an, PPIs bei medizinisch fraglicher Indikation einzusetzen (z. B. unspezifische abdominelle Beschwerden). Bei einem Drittel der Patienten könnte die bestehende PPI-Therapie nach kritischer Evaluation wieder beendet werden. 55 % der Befragten gaben an, dass PPIs ihrer Einschätzung zufolge mit relevanten Nebenwirkungen assoziiert sind. Blutungskomplikationen nach Absetzen einer PPI-Therapie wurden durch die Befragten selten beobachtet. Schlussfolgerung PPIs werden bei Patienten mit Leberzirrhose in Deutschland sehr häufig verordnet. Ein Problembewusstsein bezüglich eines insgesamt unklaren Risiko-Nutzen-Verhältnisses scheint vorhanden zu sein. Prospektive Untersuchungen sind dringend nötig, um die Evidenzlage hinsichtlich Indikation und Dauer einer PPI-Therapie bei Patienten mit Leberzirrhose zu erhärten.

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Prophylaxis against Upper Gastrointestinal Bleeding in Hospitalized Patients

Cited by 108 publications

References 68 publications

Impact of a multidisciplinary quality improvement initiative to reduce inappropriate usage of stress ulcer prophylaxis in hospitalized patients

Impact of a multidisciplinary quality improvement initiative to reduce inappropriate usage of stress ulcer prophylaxis in hospitalized patients

Protective Role of Casuarinin from Melaleuca leucadendra against Ethanol-Induced Gastric Ulcer in Rats

Einsatz von Protonenpumpenhemmern bei Patienten mit Leberzirrhose – eine Umfrage unter Hepatologen in Deutschland

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