Analysis of Guidelines for Stress Ulcer Drug Prophylaxis in and out of China_West China Medical Journal

Authors：

 XIAOGui-rong , WUXin-ya ,  XUTing

Department of Pharmacy, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

XUTing, Email: tingx2009@163.com

Keywords：

Stress ulcer; Drug prophylaxis; Proton pump inhibitor; H₂-receptor antagonist

DOI：

10.7507/1002-0179.20140678

Video：

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Objective To research on the advances of stress ulcer drug prophylaxis. Methods Guidelines for stress ulcer prophylaxis in and out of China were searched and analyzed. Risk factors for stress ulcer, recommended prevention drugs and safety of medicines were summarized. Results The risk factors for stress ulcer included mechanical ventilation, coagulopathy, severe sepsis, multiple organ failure, shock, severe head injury, burns, major trauma, older than 65 and drug use. The recommended prevention drugs included proton pump inhibitors, H₂-receptor antagonist and misoprostol, which played a role in the reduction of bleeding in intensive care units. However, recommended drugs had little function in the reduction of bleeding in general patients outside the intensive care units, which was even not recommended or supported in the clinical literature. Related adverse effects of these drugs also needed careful consideration. Conclusion Existence of risk factors for stress ulcer does not necessarily indicate the use of preventive drugs. Drug prophylaxis is used only for critically ill patients. This view summarized by the author provides a reference for physicians and pharmacists.

Citation： XIAOGui-rong, WUXin-ya, XUTing. Analysis of Guidelines for Stress Ulcer Drug Prophylaxis in and out of China. West China Medical Journal, 2014, 29(12): 2242-2245. doi: 10.7507/1002-0179.20140678 Copy

1.	Grube RR, May DB. Stress ulcer prophylaxis in hospitalized patients not in intensive care units[J]. Am J Health Syst Pharm, 2007, 64(13):1396-1400.
2.	Dial MS. Proton pump inhibitor use and enteric infections[J]. Am J Gastroenterol, 2009, 104(Suppl 2):S10-S16.
3.	Laine L. Proton pump inhibitors and bone fractures?[J]. Am J Gastroenterol, 2009, 104(Suppl 2):S21-S26.
4.	McColl KE. Effect of proton pump inhibitors on vitamins and iron[J]. Am J Gastroenterol, 2009, 104(Suppl 2):S5-S9.
5.	Allen ME, Kopp BJ, Erstad BL. Stress ulcer prophylaxis in the postoperative period[J]. Am J Health Syst Pharm, 2004, 61(6):588-596.
6.	FDA. Proton pump inhibitor drugs (PPIs): drug safety communication-low magnesium levels can be associated with long-term use[EB/OL]. (2011-03-02)[2013-07-01]. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm245275.htm.
7.	FDA. Drug safety communication:possible increased risk of fractures of the hip, wrist, and spine with the use of proton pump inhibitors[EB/OL]. (2011-03-23)[2013-07-01]. http://www.fda.gov/Drugs/DrugSafety/stmarketDrugSafetyInformationforPatientsandProviders/ucm213206.htm.
8.	FDA. Proton pump inhibitors (PPIs)-drug safety communication:clostridium difficile-associated diarrhea (CDAD) can be associated with stomach acid drugs[EB/OL]. (2012-02-08)[2013-07-01]. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm290838.htm.
9.	Abraham E. Acid suppression in a critical care environment:state of the art and beyond[J]. Crit Care Med, 2002, 30(6 Suppl):S349-S350.
10.	中华医学杂志编辑委员会. 应激性溃疡防治建议[J]. 中华医学杂志, 2002, 82(14):1000-1001.
11.	ASHP Therapeutic Guidelines on Stress Ulcer Prophylaxis. ASHP Commission on Therapeutics and approved by the ASHP Board of Directors on November 14, 1998[J]. Am J Health Syst Pharm, 1999, 56(4):347-379.
12.	普通外科应激性黏膜病变的预防与治疗——中国普通外科专家建议[J]. 中国实用外科杂志, 2009, 29(11):881-882.
13.	EAST practice management guidelines committee. Practice management guidelines for stress ulcer prophylaxis[EB/OL].[2013-07-01]. www.east.org/Content/documents/practicemanagementguidelines/stress-ulcer-prophylaxis%20.pdf.
14.	Cook DJ, Fuller HD, Guyatt GH, et al. Risk factors for gastrointestinal bleeding in critically ill patients. Canadian Critical Care Trials Group[J]. N Engl J Med, 1994, 330(6):377-381.
15.	Mulla H, Peek G, Upton D, et al. Plasma aluminum levels during sucralfate prophylaxis for stress ulceration in critically ill patients on continuous venovenous hemofiltration:a randomized, controlled trial[J]. Crit Care Med, 2001, 29(2):267-271.
16.	Stephan F, Hollande J, Richard O, et al. Thrombocytopenia in a surgical ICU[J]. Chest, 1999, 115(5):1363-1370.
17.	Cawley MJ, Wittbrodt ET, Boyce EG, et al. Potential risk factors associated with thrombocytopenia in a surgical intensive care unit[J]. Pharmacotherapy, 1999, 19(1):108-113.
18.	Lowe DO, Mamdani MM, Kopp A, et al. Proton pump inhibitors and hospitalization for clostridium difficile-associated disease:a population-based study[J]. Clin Infect Dis, 2006, 43(10):1272-1276.
19.	Laheij RJ, Sturkenboom MC, Hassing RJ, et al. Risk of community-acquired pneumonia and use of gastric acid-suppressive drugs[J]. JAMA, 2004, 292(16):1955-1960.

1. Grube RR, May DB. Stress ulcer prophylaxis in hospitalized patients not in intensive care units[J]. Am J Health Syst Pharm, 2007, 64(13):1396-1400.
2. Dial MS. Proton pump inhibitor use and enteric infections[J]. Am J Gastroenterol, 2009, 104(Suppl 2):S10-S16.
3. Laine L. Proton pump inhibitors and bone fractures?[J]. Am J Gastroenterol, 2009, 104(Suppl 2):S21-S26.
4. McColl KE. Effect of proton pump inhibitors on vitamins and iron[J]. Am J Gastroenterol, 2009, 104(Suppl 2):S5-S9.
5. Allen ME, Kopp BJ, Erstad BL. Stress ulcer prophylaxis in the postoperative period[J]. Am J Health Syst Pharm, 2004, 61(6):588-596.
6. FDA. Proton pump inhibitor drugs (PPIs): drug safety communication-low magnesium levels can be associated with long-term use[EB/OL]. (2011-03-02)[2013-07-01]. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm245275.htm.
7. FDA. Drug safety communication:possible increased risk of fractures of the hip, wrist, and spine with the use of proton pump inhibitors[EB/OL]. (2011-03-23)[2013-07-01]. http://www.fda.gov/Drugs/DrugSafety/stmarketDrugSafetyInformationforPatientsandProviders/ucm213206.htm.
8. FDA. Proton pump inhibitors (PPIs)-drug safety communication:clostridium difficile-associated diarrhea (CDAD) can be associated with stomach acid drugs[EB/OL]. (2012-02-08)[2013-07-01]. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm290838.htm.
9. Abraham E. Acid suppression in a critical care environment:state of the art and beyond[J]. Crit Care Med, 2002, 30(6 Suppl):S349-S350.
10. 中华医学杂志编辑委员会. 应激性溃疡防治建议[J]. 中华医学杂志, 2002, 82(14):1000-1001.
11. ASHP Therapeutic Guidelines on Stress Ulcer Prophylaxis. ASHP Commission on Therapeutics and approved by the ASHP Board of Directors on November 14, 1998[J]. Am J Health Syst Pharm, 1999, 56(4):347-379.
12. 普通外科应激性黏膜病变的预防与治疗——中国普通外科专家建议[J]. 中国实用外科杂志, 2009, 29(11):881-882.
13. EAST practice management guidelines committee. Practice management guidelines for stress ulcer prophylaxis[EB/OL].[2013-07-01]. www.east.org/Content/documents/practicemanagementguidelines/stress-ulcer-prophylaxis%20.pdf.
14. Cook DJ, Fuller HD, Guyatt GH, et al. Risk factors for gastrointestinal bleeding in critically ill patients. Canadian Critical Care Trials Group[J]. N Engl J Med, 1994, 330(6):377-381.
15. Mulla H, Peek G, Upton D, et al. Plasma aluminum levels during sucralfate prophylaxis for stress ulceration in critically ill patients on continuous venovenous hemofiltration:a randomized, controlled trial[J]. Crit Care Med, 2001, 29(2):267-271.
16. Stephan F, Hollande J, Richard O, et al. Thrombocytopenia in a surgical ICU[J]. Chest, 1999, 115(5):1363-1370.
17. Cawley MJ, Wittbrodt ET, Boyce EG, et al. Potential risk factors associated with thrombocytopenia in a surgical intensive care unit[J]. Pharmacotherapy, 1999, 19(1):108-113.
18. Lowe DO, Mamdani MM, Kopp A, et al. Proton pump inhibitors and hospitalization for clostridium difficile-associated disease:a population-based study[J]. Clin Infect Dis, 2006, 43(10):1272-1276.
19. Laheij RJ, Sturkenboom MC, Hassing RJ, et al. Risk of community-acquired pneumonia and use of gastric acid-suppressive drugs[J]. JAMA, 2004, 292(16):1955-1960.

West China Medical Journal

Analysis of Guidelines for Stress Ulcer Drug Prophylaxis in and out of China

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