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Co-prescription of Gastro-protectants in Hospitalized Patients: An Analysis of What We Do and What We Think We Do

Doherty, Glen A. MB PhD; Cannon, Mary D. MB; Lynch, Karen M. MB; Ayoubi, Karim Z. MB; Harewood, Gavin C. MD; Patchett, Stephen E. MD; Murray, Frank E. MD

Journal of Clinical Gastroenterology: March 2010 - Volume 44 - Issue 3 - p e51-e56
doi: 10.1097/MCG.0b013e3181a9f43b
ONLINE ARTICLES: Original Articles

Background Proton pump inhibitors (PPIs) reduce the risk of upper gastrointestinal hemorrhage (UGIH) associated with the use of many medications.

Goals To examine how clinicians perceive such risk and whether PPI coprescribing is based on an accurate assessment.

Study Methods Clinicians in a single teaching hospital were asked to estimate risk of UGIH and comment on PPI coprescription in hypothetical patients. Records of 160 hospital in-patients (median age; 74 y) were then reviewed to examine PPI prescribing and risk factors for UGIH.

Results In general, clinicians estimated UGIH risk accurately and reported low thresholds for PPI coprescription. Prescribing records showed regular PPI use increased between admission and discharge of patients from 61/160 (38%) to 93/160 (58%). Ten percent had a prior history of peptic ulcer disease. Proton pump inhibitor prescription was significantly associated with the use of aspirin and clopidogrel. Half of the patients with multiple risk factors for UGIH on admission and almost a third at discharge were not coprescribed a PPI.

Conclusions Clinicians generally estimate correctly the risk of UGIH and report a low threshold for prescribing gastro-protection. Despite this, prescribing practice does not consistently take account of relative risk of UGIH. Targeted PPI coprescribing on the basis of risk factors would lead to more rational PPI use.

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Division of Gastroenterology and Hepatology, Beaumont Hospital, Royal College of Surgeons, Beaumont, Dublin, Ireland

No funding sources to acknowledge.

Reprints: Frank E. Murray, MD, Division of Gastroenterology and Hepatology, Beaumont Hospital, Royal College of Surgeons, Beaumont, Dublin 9, Ireland (e-mail:

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's web site (

Received for publication January 26, 2009

accepted April 10, 2009

None of the authors have any conflict of interest to declare.

© 2010 Lippincott Williams & Wilkins, Inc.