Thoughts: In the hospital setting, stress ulcer prophylaxis (SUP) treatment is limited mainly to ICU patients and those with multiple traumas, spinal cord injury, or prolonged mechanical ventilation. (Rosenthal & Burchum, 2020). Proton pump inhibitors and histamine H2-receptor antagonists are commonly used for the prevention of stress ulcers. Despite current recommendations, SUP is also commonly seen among non-ICU patients in regular medical ward.

Lingering Questions: Why do healthcare providers continue using SUP in non-ICU patients despite literature recommendations?

Epiphanies: Ulcer prophylaxis treatment should be used in caution in already compromise hospitalized patients due to their serious adverse effects and other drug interactions. According to Rauch et al., indication for prophylaxis SUP in non-ICU patients included individual risk factors and concurrent risk medication such as NSAIDs and COX2 inhibitors (2021). Treatment benefits should outweigh the risks and frequent evaluation should be done to limit treatment when patient no longer meets criteria. SUP should be discontinued prior hospital discharge unless patient’s condition justifies the need for continuation of treatment. In this case, patient should be instructed to follow up with primary care provider after discharge.

Reference:

Rauch, J., Patrzyk, M., Heidecke, C. D., Schulze, T. (2021) Current practice of stress ulcer prophylaxis in a surgical patient cohort in a German university hospital. Langenbecks Arch Surgery. 406, 2849–2859. https://doi.org/10.1007/s00423-021-02325-3

Rosenthal, L. & Burchum, J. (2020). Lehne’s Pharmacotherapeutics for Advanced Practice Nurses and Physician Assistants. 2nd Edition. St. Louis Missouri: Elsevier.