Objectives: Stress ulcer prophylaxis
is commonly administered to critically ill
patients for the prevention of clinically important stress-related mucosal bleeding from the upper gastrointestinal tract. Despite widespread incorporation of stress ulcer prophylaxis
into practice around the world, questions are emerging about its indications and impact. This clinically focused article will review current controversies related to stress ulcer prophylaxis
for critically ill
adult patients, including bleeding frequency, risk factors, comparative efficacy, adverse effect profile, and overall cost-effectiveness of the available stress ulcer prophylaxis
A MEDLINE search was conducted from inception through August 2015.
Selected publications describing stress ulcer prophylaxis
in adult patients were retrieved (original research, systematic reviews, and practice guidelines); their bibliographies were also reviewed to identify additional pertinent publications.
Data from relevant publications were abstracted and summarized.
The existing evidence is organized to describe the patients most likely to benefit from stress ulcer prophylaxis
, review the comparative efficacy of proton pump inhibitors and histamine 2 receptor antagonists, the adverse effects of stress ulcer prophylaxis
, and overall cost-effectiveness.
Many stress ulcer prophylaxis
recommendations are based on older studies at risk of bias, which may not be applicable to modern practice. Stress ulcer prophylaxis
should be limited to patients considered to be at high risk for clinically important bleeding. When evaluating only the trials at low risk for bias, the evidence does not clearly support lower bleeding rates with proton pump inhibitors over histamine 2 receptor antagonists; however, proton pump inhibitors appear to be the dominant drug class used worldwide today. The current rate of upper gastrointestinal bleeding and the relative adverse effects of acid suppression on infectious risk may drive not only the effectiveness, but also the cost-effectiveness of stress ulcer prophylaxis
today. Research is currently underway to better address these issues.