Archief Roodbont

Acid-suppressive medication helps to prevent stress-related gastrointestinal (GI) bleeding in critically ill patients, but the practice has spread to noncritical patients despite no good evidence of benefit. Various studies have shown that up to 70% of all inpatients receive acid-suppressive medication. Boston investigators sought to supplement the results of smaller randomized trials with a retrospective cohort study of about 79,000 adults admitted for diagnoses other than GI bleeding; about 46,000 (59%) of them received acid-suppressive medications.

The rate of nosocomial GI bleeding (i.e., bleeding occurring more than 24 hours after admission) was 0.29%. In adjusted analyses that compared patients treated and not treated with acid-suppressive medication, the rate of GI bleeding was lower by roughly 37% in those taking medication.

Comment: These results, while retrospective and uncontrolled, further support the recommendation against use of acid-suppressive medication in noncritical patients. The benefits are very small with such use, and patients are exposed to a wide range of risks, including the development Clostridium difficile infections and hospital-acquired pneumonia.

— Thomas L. Schwenk, MD

Published in Journal Watch General Medicine June 30, 2011