Stress ulcer prophylaxis in medical ICU patients: annual utilization in relation to the incidence of endoscopically proven stress ulceration.
OBJECTIVE
To measure changes in the proportion of medical intensive care unit (MICU) patients prescribed pharmacologic stress ulcer prophylaxis therapy over a 4-year period in relation to the incidence of stress-related ulceration detected by endoscopy at our institution.


METHODS
Retrospective 4-year review of pharmacy and endoscopy databases.


METHODS
A 35-bed MICU.


METHODS
Patients (n = 2941) admitted to the MICU for longer than 24 hours, between January 1, 1993, and December 31, 1996, without acute gastrointestinal hemorrhage on admission.


METHODS
Records were reviewed to identify patients prescribed pharmacologic stress ulcer prophylaxis (> 24 h of sucralfate or a histamine2-receptor antagonist [H2RA]), and patients with evidence of stress ulceration during endoscopy.


RESULTS
The number of patients per year receiving stress ulcer prophylaxis significantly (p < 0.001) decreased between 1993 and 1996: 1993, 492/693 (71%); 1994, 478/798 (60%); 1995, 295/670 (44%); 1996, 164/780 (21%). There was no difference between years in the median duration of stress ulcer prophylaxis therapy or the proportion of patients receiving sucralfate versus H2RA therapy. There was no difference (p = 0.91) between years in the annual incidence of definite or possible stress-related ulceration: 1993, 6/693 (0.87%); 1994, 5/798 (0.63%); 1995, 6/670 (0.90%); 1996, 5/780 (0.64%).


CONCLUSIONS
The incidence of endoscopically proven stress-related ulceration has remained unchanged over the past 4 years in our MICU despite significantly fewer patients receiving pharmacologic stress ulcer prophylaxis therapy.
Department of Pharmacy Services, Henry Ford Hospital, Detroit, MI, USA. jdevlin@dmc.org
J W
JW
Devlin
T
T
Ben-Menachem
S K
SK
Ulep
M J
MJ
Peters
R P
RP
Fogel
B J
BJ
Zarowitz
D000897:Anti-Ulcer Agents / Q000627:therapeutic use*; D004363:Drug Utilization; D005260:Female; D005773:Gastroscopy; D006635:Histamine H2 Antagonists / Q000627:therapeutic use; D006743:Hospital Bed Capacity, under 100; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D010438:Peptic Ulcer Hemorrhage / Q000517:prevention & control; D012189:Retrospective Studies; D013276:Stomach Ulcer / Q000209:etiology / Q000473:pathology / Q000517:prevention & control*; D013312:Stress, Physiological / Q000150:complications*; D013392:Sucralfate / Q000627:therapeutic use
D000897:Anti-Ulcer Agents; D006635:Histamine H2 Antagonists; D013392:Sucralfate