Reducing Overuse of Proton Pump Inhibitors for Stress Ulcer Prophylaxis and Nonvariceal Gastrointestinal Bleeding in the Hospital: A Narrative Review and Implementation Guide

Abstract

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.

An Updated Review and a Case Report: Stress Ulcer Prophylaxis

“…A retrospective study found that 54% of non-ICU patients were discharged home on anti-secretory therapy, despite none of them meeting evidence-based criteria for SUP: a very unnecessary additional expenditure from SUP overutilization [33]. In parallel, a separate study found that 51.9% of patients who downgraded from the ICU were maintained on SUP, even though there were no indications for its use, increasing risks that were previously mentioned [34][35][36].…”

Potentially Inappropriate Medications in Hospitalized Older Patients in Tabuk, Saudi Arabia Using 2023 Beers Criteria: A Retrospective Multi-Centric Study

“… 37 PPIs are most commonly used to treat ulcers and gastritis and are more frequently used in hospitalized patients to prevent stress ulcers. 38 Long-term use of PPIs results in renal toxicity or Clostridium difficile infection. 39 Pharmacists should intervene to improve the medication prescribing by reviewing the medication chart, assessing the appropriateness using different tools and discontinuing inappropriate medications.…”

A combination of Beers and STOPP criteria better detects potentially inappropriate medications use among older hospitalized patients with chronic diseases and polypharmacy: a multicenter cross-sectional study

“…PPIs were the second most commonly prescribed PIM item in this study population, and the incidence is similar to that of other related studies, 11.3%-42.6% [ 33 , 34 ]. PPIs are commonly used in treating peptic ulcers and chronic gastritis and are also widely used to prevent stress ulcers in hospitalized patients [ 35 ]. The long-term use of PPI in older patients leaves the patients more prone to complications such as Clostridium difficile infection or renal toxicity [ 36 ].…”