Stress-related mucosal disease (SRMD), an acute erosive gastritis that may potentially lead to stress ulcers and/or stress-related injuries, remain a significant concern for patients within the critical care setting.1 The initiation of anti-secretory therapy (AST) for stress ulcer prophylaxis (SUP) within the critical care setting has gained widespread use as it has been noted to protect against SRMD and clinically important gastrointestinal (GI) bleeding.2 Although the use of these agents is well established in the critical care setting, several research studies have confirmed the extensive and inappropriate use of AST in both intensive care unit (ICU) and non-ICU patients, based on current recommendations.3
Proton pump inhibitors, in most hospital settings, have been the mainstay drug of choice for SUP. Since the introduction of the first proton pump inhibitor (PPI) in the late 1980s, the use of PPIs has risen dramatically, with sharp increases noted up to 456% in the 1990s.4 As one of the world’s most frequently prescribed medications5, expenditures are estimated to surpass seven billion dollars annually,6 falling only second to HMG CoA reductase inhibitors. There is strong evidence demonstrating that SUP can be an efficacious and effective preventative care measure. However, a perceived favorable safety profile has contributed to the significant overutilization of PPIs.
STRESS ULCER-RELATED RISK FACTORS
Stress ulcers are either single or multiple gastroduodenal