title: Stress ulcer prophylaxis in non-critically ill patients: a prospective evaluation of current practice in a general surgery department.
abstract: OBJECTIVE
  There is little evidence regarding the benefit of stress ulcer prophylaxis (SUP) outside a critical care setting. Overprescription of SUP is not devoid of risks. This prospective study aimed to evaluate the use of proton pump inhibitors (PPIs) for SUP in a general surgery department.
  
  
  METHODS
  Data collection was performed prospectively during an 8-week period on patients hospitalized in a general surgery department (58 beds) by pharmacists. Patients with a PPI prescription for the treatment of ulcers, gastro-oesophageal reflux disease, oesophagitis or epigastric pain were excluded. Patients admitted twice during the study period were not reincluded. The American Society of Health-System Pharmacists guidelines on SUP were used to assess the appropriateness of de novo PPI prescriptions.
  
  
  RESULTS
  Among 255 patients in the study, 138 (54%) received a prophylaxis with PPI, of which 86 (62%) were de novo PPI prescriptions. A total of 129 patients (94%) received esomeprazole (according to the hospital drug policy). The most frequent dosage was at 40 mg once daily. Use of PPI for SUP was evaluated in 67 patients. A total of 53 patients (79%) had no risk factors for SUP. Twelve and two patients had one or two risk factors, respectively. At discharge, PPI prophylaxis was continued in 33% of patients with a de novo PPI prescription.
  
  
  CONCLUSIONS
  This study highlights the overuse of PPIs in non-intensive care unit patients and the inappropriate continuation of PPI prescriptions at discharge. Treatment recommendations for SUP are needed to restrict PPI use for justified indications.
authors.affiliation: School of Pharmaceutical Sciences, University of Geneva, University of Lausanne, Geneva, Switzerland.
authors.forename: Coraline
authors.initials: C
authors.lastname: Bez
authors.forename: Nancy
authors.initials: N
authors.lastname: Perrottet
authors.forename: Tobias
authors.initials: T
authors.lastname: Zingg
authors.forename: En-Ling
authors.initials: EL
authors.lastname: Leung Ki
authors.forename: Nicolas
authors.initials: N
authors.lastname: Demartines
authors.forename: André
authors.initials: A
authors.lastname: Pannatier
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000897:Anti-Ulcer Agents / Q000627:therapeutic use; D064098:Esomeprazole / Q000627:therapeutic use; D005260:Female; D006801:Humans; D057970:Inappropriate Prescribing / Q000706:statistics & numerical data*; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D010437:Peptic Ulcer / Q000517:prevention & control* / Q000523:psychology; D011446:Prospective Studies; D054328:Proton Pump Inhibitors / Q000627:therapeutic use*; D013312:Stress, Physiological; D013503:Surgery Department, Hospital; D013557:Switzerland; D055815:Young Adult
chemical_list: D000897:Anti-Ulcer Agents; D054328:Proton Pump Inhibitors; D064098:Esomeprazole