Materiały źródłowe

• #1 Peptic Ulcer Disease: A Brief Review of Conventional Therapy and Herbal Treatment Options

  https://www.mdpi.com/2077-0383/8/2/179

  Peptic ulcer is a chronic disease affecting up to 10% of the world’s population. […] Conventional treatments of peptic ulcers, such as proton pump inhibitors (PPIs) and histamine-2 (H2) receptor antagonists, have demonstrated adverse effects, relapses, and various drug interactions. […] Hence, this review presents common medicinal plants that may be used for the treatment or prevention of peptic ulcers. […] Many strategies are available for the prevention of NSAID and aspirin-associated gastroduodenal ulcers and their complications, such as the co-therapy of NSAIDs with a PPI, H2 receptor antagonist, or misoprostol; the use of COX-2-selective NSAIDs; or their combination with a gastroprotective agent. PPIs are the most popular and effective prophylactic agents. […] The combination of COX-2-selective NSAIDs and a PPI offers the best protection against peptic ulcer complications.

• #2 Diagnosis and Treatment of Peptic Ulcer Disease and H. pylori Infection | AAFP

  https://www.aafp.org/pubs/afp/issues/2015/0215/p236.html

  The most common causes of peptic ulcer disease (PUD) are Helicobacter pylori infection and use of nonsteroidal anti-inflammatory drugs (NSAIDs). […] Recommended therapies for preventing PUD in these patients include misoprostol and proton pump inhibitors. […] Therapies aimed at protecting the mucosa include the prostaglandin analogue misoprostol (Cytotec), histamine H2 receptor antagonists, a cyclooxygenase-2 (COX-2) inhibitor instead of a standard NSAID, and PPIs. A Cochrane review on the effectiveness of these therapies compared with placebo suggests that high-risk patients should take a COX-2 inhibitor with a PPI for the greatest gastrointestinal safety. […] The ACG guideline recommends that patients who will be on long-term NSAID therapy be tested for H. pylori infection, and eradication therapy should be given if positive.

• #3 Peptic ulcer disease: Treatment and secondary prevention – UpToDate

  https://www.uptodate.com/contents/peptic-ulcer-disease-treatment-and-secondary-prevention

  Peptic ulcer disease: Treatment and secondary prevention […] PREVENTION OF RECURRENCE […] Aspirin/nonsteroidal anti-inflammatory drug (NSAID) avoidance […] H. pylori eradication […] Maintenance antisecretory therapy […] Eradicate Helicobacter pylori (H. pylori) infection — Patients with peptic ulcers should be tested for infection with H. pylori and treated accordingly […] Eradication of H. pylori in patients with peptic ulcer disease is associated with higher healing rates in patients with duodenal and gastric ulcers […] In addition, eradication of H. pylori infection is associated with lower ulcer recurrence rates in patients with gastric and duodenal ulcers who are not placed on maintenance antisecretory therapy […] Discontinue nonsteroidal anti-inflammatory drugs (NSAIDs) — Patients with peptic ulcers should be advised to avoid NSAIDs. NSAIDs, including aspirin, increase the risk of peptic ulcer disease and are associated with an increased risk of complications from a peptic ulcer.

• #4 Peptic ulcer – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/peptic-ulcer/symptoms-causes/syc-20354223

  To help prevent peptic ulcers: […] Take care with pain relievers. If you often use NSAIDs, which can increase your risk of peptic ulcer, take steps to reduce your risk of stomach problems. For instance, take pain relievers with meals. […] If you smoke, find a way to quit. Quitting smoking can lower your risk of peptic ulcer. Talk with your healthcare professional for help with quitting.

• #5 Peptic Ulcer Disease: Symptoms, Causes, Treatment & Medication

  https://my.clevelandclinic.org/health/diseases/10350-peptic-ulcer-disease

  How can I lower my risk of peptic ulcers? The most important things you can do to prevent peptic ulcer disease are to: […] Find and eradicate H. pylori. Most people who have an H. pylori infection aren’t aware of it. You can find out if you have it by taking a simple urea breath test. If you have it, you can treat it proactively (before it causes any problems). If you’ve had it and treated it before, it’s a good idea to retest because sometimes it comes back. […] Use NSAIDs only as directed. If you’re in the habit of managing daily aches and pains with NSAIDs, make sure you aren’t taking more than the recommended dose. If you’ve already had peptic ulcer disease, you probably shouldn’t take them at all. But if you have to, you should take them with another medication to protect your lining.

• #6 Peptic Ulcer Disease | AAFP

  https://www.aafp.org/pubs/afp/issues/2007/1001/p1005.html

  Peptic ulcer disease is a problem of the gastrointestinal tract characterized by mucosal damage secondary to pepsin and gastric acid secretion. […] In patients with peptic ulcer disease, Helicobacter pylori should be eradicated to assist in healing and to reduce the risk of gastric and duodenal ulcer recurrence. […] In patients with peptic ulcers, proton pump inhibitors provide acid suppression, healing rates, and symptom relief superior to other antisecretory therapies. […] Patients with bleeding peptic ulcers should be given a proton pump inhibitor to reduce transfusion requirements, need for surgery, and duration of hospitalization. […] Proton pump inhibitors and misoprostol (Cytotec) minimize the ulcerogenic potential of NSAIDs and reduce NSAID-related ulcer recurrence. […] Early institution of PPI prophylaxis with oral or intravenous pantoprazole (Protonix) minimizes ulcer risk.

• #6 Peptic Ulcer Disease | AAFP

  https://www.aafp.org/pubs/afp/issues/2007/1001/p1005.html

  Maintenance therapy with H2 blockers or proton pump inhibitors prevents recurrence in high-risk patients (e.g., those with a history of complications, frequent recurrences, ulcers testing negative for H. pylori, refractory giant ulcers, or severely fibrosed ulcers), but it is not generally recommended for patients in whom H. pylori has been eradicated and who are not taking NSAIDs long-term.

• #7 Peptic ulcers: Research summaries – Preventing peptic ulcers – InformedHealth.org – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK310269/

  The proton pump inhibitors used in the studies were lansoprazole (15 mg or 30 mg per day), omeprazole (20 mg per day) and pantoprazole (40 mg per day). The studies lasted up to six months. They showed that all of these proton pump inhibitors clearly lowered the risk of getting peptic ulcers. […] All three types of stomach-protecting medication can lower the risk of getting peptic ulcers. Proton pump inhibitors and H2 blockers appear to be very well tolerated. […] The risk of peptic ulcers can be reduced by taking the lowest possible dose of painkillers, and only taking them for as long as necessary.

• #8 Peptic ulcer disease and non-steroidal anti-inflammatory drugs – Australian Prescriber

  https://australianprescriber.tg.org.au/articles/peptic-ulcer-disease-and-non-steroidal-anti-inflammatory-drugs.html

  Non-steroidal anti-inflammatory drugs including low-dose aspirin are some of the most commonly used medicines. They are associated with gastrointestinal mucosal injury. […] Before prescribing, it is important to assess the patients gastrointestinal risk factors such as age and history of peptic ulcers. Patients at high risk may require co-prescription to reduce the risk of peptic ulcers. […] A daily dose of a proton pump inhibitor is the most effective method of reducing the risk of ulcers induced by non-steroidal anti-inflammatory drugs. […] In patients with multiple risk factors, physicians need to assess these risks before prescribing NSAIDs and adopt risk-minimising strategies. […] Before prescribing an NSAID, prophylactic proton pump inhibitor therapy needs to be offered to patients with a past history of peptic ulcer disease and those on dual antiplatelet therapy or anticoagulant therapy.

• #9 Preventing peptic ulcers | informedhealth.org

  https://www.informedhealth.org/preventing-peptic-ulcers.html

  The proton pump inhibitors used in the studies were lansoprazole (15 mg or 30 mg per day), omeprazole (20 mg per day) and pantoprazole (40 mg per day). The studies lasted up to six months. They showed that all of these proton pump inhibitors clearly lowered the risk of getting peptic ulcers: […] Proton pump inhibitors may cause headaches, diarrhea, constipation and stomach pain. […] The studies on H2 blockers mainly looked at the drugs famotidine and ranitidine. These studies lasted up to one year. Both drugs were shown to prevent peptic ulcers, but their effectiveness greatly depended on the dose taken. […] There were also a lot of studies on misoprostol. The studies showed that this drug can prevent the development of peptic ulcers too. […] All three types of stomach-protecting medication can lower the risk of getting peptic ulcers. Proton pump inhibitors and H2 blockers appear to be very well tolerated.

• #10 Peptic ulcer disease – Wikipedia

  https://en.wikipedia.org/wiki/Peptic_ulcer_disease

  Prevention of peptic ulcer disease for those who are taking NSAIDs (with low cardiovascular risk) can be achieved by adding a proton pump inhibitor (PPI), an H2 antagonist, or misoprostol. […] NSAIDs of the COX-2 inhibitors type may reduce the rate of ulcers when compared to non-selective NSAIDs. […] PPI is the most popular agent in peptic ulcer prevention. […] However, there is no evidence that H2 antagonists can prevent stomach bleeding for those taking NSAIDs. […] Although misoprostol is effective in preventing peptic ulcer, its properties of promoting abortion and causing gastrointestinal distress limit its use. […] For those with high cardiovascular risk, naproxen with PPI can be a useful choice. […] Otherwise, low-dose aspirin, celecoxib, and PPI can also be used.

• #11 The Medical Letter Home Page | The Medical Letter, Inc.

  https://secure.medicalletter.org/TML-article-1333b

  Misoprostol (Cytotec, and others), a synthetic prostaglandin E1 analog, can prevent gastric and duodenal ulcers in patients on chronic NSAID therapy. […] A meta-analysis of five prospective trials of H. pylori eradication showed a statistically significant reduction in the risk of endoscopic ulcers in patients who had not yet begun NSAID treatment, but not among those already taking an NSAID. […] There is no convincing evidence that long-term use of aluminum- or magnesium-containing antacids can prevent development of peptic ulcers in patients taking aspirin or NSAIDs. […] Taking a proton pump inhibitor can prevent aspirin- or NSAID-associated ulcers detected on endoscopy.

• #11 The Medical Letter Home Page | The Medical Letter, Inc.

  https://secure.medicalletter.org/TML-article-1333b

  Aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) are common causes of peptic ulcer disease. Patients infected with Helicobacter pylori who take aspirin or another NSAID have an especially high risk. […] Drugs that have been tried for prevention of ulcers in patients taking NSAIDs including H2-receptor antagonists, proton pump inhibitors (PPIs), aluminum- or magnesium-containing antacids, the prostaglandin misoprostol (Cytotec ,and others), and antibiotics to eradicate H. pylori. […] High doses of an H2-receptor antagonist have been shown to prevent NSAID-related gastric ulcers. […] A randomized, double-blind trial in 169 patients taking NSAIDs compared omeprazole 20 mg once daily with placebo. […] PPIs have been shown to be more effective than H2-receptor antagonists in prevention of NSAID-related ulcers and at least as effective as misoprostol.

• #12 Peptic ulcer disease – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/peptic-ulcer-disease/

  For patients requiring chronic NSAID therapy, consider acid suppression medication for ulcer prevention. […] Misoprostol: Consider as an alternative to PPIs for ulcer prophylaxis in patients at high risk of developing NSAID-induced GI toxicity (e.g., older individuals, those with a history of complicated peptic ulcer). […] Nonpharmacological measures: e.g., avoid NSAIDs, restrict alcohol. […] Consider switching NSAID to an alternative agent (e.g., an oral analgesic), if appropriate. […] Modify risk factors for NSAID-induced GI toxicity where possible, e.g.: Decrease NSAID dose to the lowest effective dose. […] In patients requiring long-term NSAID therapy consider testing for H. pylori, followed by H. pylori eradication if positive. […] Determine the need for gastric mucosal protection based on the presence of risk factors for NSAID-induced GI toxicity. […] In general, PPIs are preferred; see PPIs in Acid suppression medications for dosages. […] Reassess indications for gastric mucosal protection periodically; discontinue when no longer indicated.

• #13

  https://link.springer.com/article/10.1007/s00535-021-01769-0

  In elderly or patients with severe complications, administration of PPIs is recommended for the prevention of NSAID-induced ulcers. […] COX-2 selective inhibitors are recommended for the prevention of NSAID-induced ulcers. […] Prevention with anti-ulcer agents is recommended for patients taking COX-2 selective inhibitors with a history of peptic ulcers or hemorrhage. […] PPIs or H2RAs is recommended for the reduction of the incidence and prevalence of LDA-related peptic ulcers. […] PPIs in addition to the eradication of H. pylori infection are recommended for the reduction of the incidence and prevalence rate of LDA-related PUB. […] PPI or VPZ is recommended to reduce the recurrence rate of LDA-related peptic ulcers.

• #13

  https://link.springer.com/article/10.1007/s00535-021-01769-0

  In patients with a history of ulcers receiving LDA therapy, PPIs or VPZ are recommended and the administration of a histamine 2-receptor antagonist is suggested for the prevention of ulcer recurrence. […] In DAPT, we recommend the combined use of PPIs to prevent upper gastrointestinal bleeding (UGIB). […] If taking warfarin, we suggest using PPIs to prevent UGIB in patients taking antiplatelet drugs or NSAIDs in combination. […] Prevention of NSAID-induced ulcers by administration of PPIs is necessary and suggested even in patients with no history of ulcers. […] PPIs are recommended, and VPZ is suggested to prevent NSAID-induced ulcers in patients with a history of ulcers. […] In patients receiving combinations of NSAIDs and glucocorticoids or antithrombotic drugs, administration of a COX-2 inhibitor is recommended for ulcer prevention.

• #14 Peptic ulcer primary prevention – wikidoc

  https://www.wikidoc.org/index.php/Peptic_ulcer_primary_prevention

  Helicobacter pylori eradication has been proved as the most cost-effective strategy for primary prevention of NSAID-associated peptic ulcer, especially for patients above the age of 50 years. […] Lifestyle changes may help prevent peptic ulcers: […] Avoid aspirin, ibuprofen, naproxen, and other NSAIDs. Try acetaminophen instead. If you must take such medicines, talk to your doctor first. […] Don’t smoke or chew tobacco. […] Limit alcohol to no more than two drinks per day. […] Patients on long-term NSAID therapy and with the following risk factors, present an elevated risk of gastrointestinal bleeding and perforation: […] History of ulcer complication. […] History of ulcer disease (non-bleeding). […] Dual antiplatelet therapy. […] Concomitant anticoagulant therapy. […] 60 years. […] Corticosteroid use. […] Dyspepsia. […] GERD symptoms. […] Helicobacter pylori infection.

• #15 Guidelines of Prevention and Treatment for NSAID-related Peptic Ulcers

  https://www.kjg.or.kr/journal/view.html?uid=4147&vmd=Full

  Non-steroidal anti-inflammatory drugs (NSAIDs) are among the most commonly used medications in Korea. Gastrointestinal toxicity, including peptic ulcer, is a common adverse effect of NSAIDs. Risk factors for NSAID-related peptic ulcer include a previous history of peptic ulcer, advanced age, high dose, concomitant use of corticosteroids, anticoagulants, other NSAIDs including low-dose aspirin. Preventive measure(s), such as COX-2 inhibitor, proton pump inhibitor or misoprostrol, should be done for patients requiring NSAID therapy who have high-risk factor(s) for peptic ulcer. […] Low dose aspirin also increases the risk of peptic ulcer, so preventive measure(s) should be done for high-risk patients. The eradication of Helicobacter pylori is recommended for high-risk NSAID-users.

• #16 Preventing peptic ulcers | informedhealth.org

  https://www.informedhealth.org/preventing-peptic-ulcers.html

  The risk of peptic ulcers can be reduced by taking the lowest possible dose of painkillers, and only taking them for as long as necessary. […] It is best to talk to a doctor about how high your own personal risk of getting a peptic ulcer is, as well as what medications you could take to protect your stomach.

• #17 Peptic Ulcer: Causes, Symptoms, Treatment & Prevention | Medcare

  https://www.medcare.ae/en/health-library/peptic-ulcers-symptoms-causes-treatment-and-prevention.html

  Prevention is always better than cure peptic ulcers can be prevented by making the following lifestyle changes: […] Reducing alcohol consumption […] Reducing use of NSAIDs such as aspirin ibuprofen. Paracetamols are a better alternative to use […] Quitting or limiting smoking […] Eating less spicy foods incorporating more fruits vegetables in the existing diet […] Manage stress […] Prevent H. pylori infection by ensuring cleanliness of drinking water food by washing your hs before a meal. Also, make sure your food, especially meat, is cooked properly, all the way through.

• #18

  https://link.springer.com/article/10.1007/s00535-016-1166-4

  Eradication of H. pylori is recommended as a preventive care for the recurrence of peptic ulcer. Recommendation 1, 100 % agreed, evidence level A. […] The effectiveness of H. pylori eradication therapy after healing of a hemorrhagic peptic ulcer to reduce re-bleeding was proven by two meta-analyses and some RCTs. Furthermore, H. pylori eradication therapy has been shown to decrease the cost per year in patients. […] Successful H. pylori eradication was reported to provide a benefit for gastric or duodenal ulcer healing. Successful eradication of H. pylori accelerates gastric or duodenal ulcer healing compared with unsuccessful eradication. […] In recent years, H. pylori eradication therapy is a first step treatment for gastric ulcer patients. Because it has been shown that H. pylori eradication therapy prevents peptic ulcer recurrence, gastric ulcer patients for whom non-eradication therapy is appropriate are few.

• #18

  https://link.springer.com/article/10.1007/s00535-016-1166-4

  In non-eradication therapy for gastric ulcers, maintenance treatment is effective for the prevention of ulcer recurrence in healed gastric ulcers, and this treatment is recommended. Recommendation 1, 100 % agreed, evidence level A. […] In non-eradication therapy for duodenal ulcers, maintenance treatment is effective for the prevention of ulcer recurrence in healed duodenal ulcers, and this treatment is recommended. Recommendation 1, 100 % agreed, evidence level A.

• #19

  https://openarchive.ki.se/articles/thesis/Complicated_peptic_ulcer_disease_prevention_and_treatment/26923669

  Peptic ulcer is a common disease worldwide and its complications can cause serious clinical problems. […] Helicobacter pylori (H. pylori) is the main risk factor for peptic ulcer, and eradication of this bacterium is an important part of the treatment. […] Delays in H. pylori eradication after peptic ulcer diagnosis must be avoided, since these might time-dependently increase the risk of ulcer recurrence, ulcer complications and gastric cancer.

• #20 Peptic ulcer prevention and diet

  https://www.mymed.com/diseases-conditions/peptic-ulcers-stomach-and-duodenal/peptic-ulcer-prevention-and-diet

  Peptic ulcer prevention […] It may be possible to prevent an ulcer from developing and reduce any risk factors you may have when following the above home remedies as well as some of the below: […] Protecting yourself from any potential infections There are a number of steps that you can take to afford you protection against the spread of H. pylori bacteria. It is not quite clear as to how the bacterium spreads, but evidence suggests that is may be transmitted through personal contact with an infected person or through contaminated water and food. Through good practices of personal hygiene and washing your hands with water and soap before eating and after going to the bathroom you may be able to reduce your risk. […] Using caution when taking painkillers The regular use of painkillers will increase your risk of developing a peptic ulcer. There are ways that painkillers can be taken. Taking your medication with meals and in smaller doses may also help. It is best to work with your doctor regarding the use of painkillers.

• #20 Peptic ulcer prevention and diet

  https://www.mymed.com/diseases-conditions/peptic-ulcers-stomach-and-duodenal/peptic-ulcer-prevention-and-diet

  The following can also be used for those who suffer from gastritis. […] Those who follow these eating guidelines will note a significant improvement in their ulcer symptoms and their general well-being. […] It is best to stop eating for at least two hours before you go to bed as this will help prevent any heartburn and indigestion. It is also advised that you eat smaller meals more frequently as this will be easier on your stomach and digestion.

• #21 Peptic Ulcer – Harvard Health

  https://www.health.harvard.edu/a_to_z/peptic-ulcer-a-to-z

  Peptic ulcers are not usually preventable the first time around. […] Good hygiene may limit the spread of H. pylori somewhat. This includes washing your hands thoroughly before eating and after using the bathroom. […] Recurrent ulcers from H. pylori can usually be prevented if you get appropriate treatment for your first ulcer. This should include antibiotics that kill the bacteria. […] You may help to prevent peptic ulcers by: Avoiding smoking, Avoiding excessive alcohol use, Limiting the use of NSAIDs for pain. […] To prevent another ulcer, people who have had a peptic ulcer should avoid: Aspirin (unless a low dose is needed to prevent a heart attack or stroke), NSAIDs, Excessive alcohol, Smoking.

• #22 Stress Ulcer Prophylaxis Within the ICU

  https://www.uspharmacist.com/article/stress-ulcer-prophylaxis-within-the-icu

  Stress ulceration poses a significant threat to critically ill patients, necessitating stress ulcer prophylaxis (SUP). […] While the choice of the optimal prophylactic agent remains uncertain, proton pump inhibitors (PPIs) often take precedence due to their effectiveness in gastric acid suppression. […] Evidence has also suggested an association between stress ulceration and an increased length of stay in the ICU. […] As such, stress ulcer management primarily focuses on preventive measures, commonly referred to as stress ulcer prophylaxis (SUP). […] While the optimal choice of prophylactic agent remains uncertain, PPIs are often favored over alternatives due to their efficacy in suppressing gastric acid. […] Despite concerns about potential adverse effects associated with PPIs, evidence suggests that the benefits of SUP outweigh the risks.

• #23 Stress ulcers in the intensive care unit: Diagnosis, management, and prevention – UpToDate

  https://www.uptodate.com/contents/stress-ulcers-in-the-intensive-care-unit-diagnosis-management-and-prevention

  Stress ulcerations are common in intensive care unit (ICU) patients, some of which can cause hemorrhage. As a consequence, many critically ill patients require prophylaxis for primary prevention of bleeding from stress ulceration or treatment for stress ulcer-related bleeding. […] Primary prevention of GI bleeding from stress ulcers is known as stress ulcer prophylaxis (SUP).

• #24 Do not prescribe “gastroprotection” for stress ulcer prophylaxis in medical patients unless there is a high risk of bleeding. | Choosing Wisely Italia

  https://choosingwiselyitaly.org/en/raccomandazione-prof/do-not-prescribe-gastroprotection-for-stress-ulcer-prophylaxis-in-medical-patients-unless-there-is-a-high-risk-of-bleeding/

  Do not prescribe gastroprotection for stress ulcer prophylaxis in medical patients unless there is a high risk of bleeding. […] According to international guidelines, the prophylaxis of peptic stress ulcers with antisecretive drugs, represented by H2 receptor antagonists and proton pump inhibitors, is not routinely indicated for the medical patient, unless it is related to patients admitted to intensive care or at high risk of bleeding. […] The term gastroprotection is indeed inappropriate, hiding the possible negative effects linked to the prolonged use of proton pump inhibitors, such as Clostridioides difficile colitis, pneumonia, bone fractures, chronic renal failure, interference with platelet function, vitamin B12 deficiency, alterations of the intestinal microbiota. […] Furthermore, it has been observed that the administration of these drugs during hospitalization tends to continue after discharge, with significant negative effects on patients health and leading to higher costs for National Health System.

• #25 Stress Ulcer Prophylaxis

  https://www.east.org/education-resources/practice-management-guidelines/details/stress-ulcer-prophylaxis

  Stress ulcer prophylaxis has historically been a disease process with a high degree of prevalence in the setting of burns and trauma. […] Prophylaxis is recommended for all patients with: Mechanical ventilation, Coagulopathy, Traumatic brain injury, Major burn injury. […] Prophylaxis is recommended for all ICU patients with: Multi-trauma, Sepsis, Acute renal failure. […] Prophylaxis is recommended for all ICU patients with: ISS15, Requirement of high-dose steroids (250 mg hydrocortisone or equivalent per day). […] There is no difference between H2 antagonists, cytoprotective agents, and some proton pump inhibitors. […] Antacids should not be used as stress ulcer prophylaxis. […] During mechanical ventilation or intensive care unit stay. […] Until able to tolerate enteral nutrition.

• #25 Stress Ulcer Prophylaxis

  https://www.east.org/education-resources/practice-management-guidelines/details/stress-ulcer-prophylaxis

  All critically ill patients with associated risk factors should receive chemical prophylaxis for stress ulceration. […] All agents (with the exception of antacids) appear equally adequate for prophylaxis against stress ulceration. […] The duration of treatment is ill-defined, but should be maintained while risk factors are present, the patient is admitted to the intensive care unit, or for at least one week after onset of critical illness. […] There is currently insufficient evidence to warrant cessation of prophylaxis in the setting of enteral nutrition if other risk factors exist, or to eliminate stress ulcer prophylaxis entirely.

• #26 Stress Ulcer Prophylaxis

  https://med.uth.edu/surgery/stress-ulcer-prophylaxis/

  Stress ulcer prophylaxis is indicated for select patients (Grade Level of Quality moderate; USPSTF strength of recommendation C). […] Stress ulcer prophylaxis should be given with the following conditions: Mechanical Ventilation, Disease-associated coagulopathy, Major burn injury 30% TBSA, Scheduled NSAID use, PPI use as an outpatient (i.e, prior history of PUD). […] It has become standard of care for patients to receive chemical stress ulcer prophylaxis if requiring mechanical ventilation, having coagulopathy, suffering traumatic brain injury or major burns, or have a personal history of peptic ulcer disease (PUD). […] H2-receptor antagonists are commonly used and have shown similar efficacy in preventing clinically significant GI bleeding. […] More recent meta-analyses have reported a decreased rate of bleeding with PPIs when compared to H2 blockers. […] Overall, mostly low quality data regarding these topics exists begging the need for a large multi-center randomized trial to help clarify these questions.

• #27 List of 9 Stress Ulcer Prophylaxis Medications Compared

  https://www.drugs.com/condition/stress-ulcer-prophylaxis.html

  Action taken to prevent a stress ulcer, an ulcer of the duodenum in a patient with extensive superficial burns, intracranial lesions, or severe bodily injury. […] The medications listed below are related to or used in the treatment of this condition. […] for pantoprazole to treat Stress Ulcer Prophylaxis […] for sucralfate to treat Stress Ulcer Prophylaxis […] for Carafate to treat Stress Ulcer Prophylaxis […] for cimetidine to treat Stress Ulcer Prophylaxis […] for Tagamet HB to treat Stress Ulcer Prophylaxis.

• #28

  https://experts.mcmaster.ca/display/publication190506

  Acute upper gastrointestinal bleeding in intensive care unit (ICU) patients may occur due to peptic ulcer disease, adverse drug effects, gastric tube lesions, acute renal failure, liver failure or stress-induced gastric mucosal lesions. […] Preventive strategies aim to reduce gastric acidity (histamine H2 receptor antagonists, antacids), strengthen mucosal defensive mechanisms (sucralfate, antacids, pirenzepine) and normalise gastric mucosal microcirculation (sucralfate, pirenzepine). […] However, the most important prophylactic measure is an optimised resuscitation and ICU regime aiming to improve oxygenation and microcirculation. […] Stress ulcer prophylaxis is indicated only in patients at risk, and not in every ICU patient. […] The selection of drugs today depends not only on efficacy but also on possible adverse effects and on costs. In this regard, the most cost-effective drug is sucralfate.

• #29 HelixTalk #185 – They Are Late, but Don’t Stress: The New 2024 Stress Ulcer Prophylaxis Guidelines – Rosalind Franklin University

  https://www.rosalindfranklin.edu/academics/college-of-pharmacy/helixtalk/helixtalk-185-they-are-late-but-don-t-stress-the-new-2024-stress-ulcer-prophylaxis-guidelines/

  After 25 years, the stress ulcer prophylaxis guidelines have been updated by SCCM and ASHP. These guidelines make 13 recommendations in a PICO format. […] The SCCM/ASHP guidelines recommend stress ulcer prophylaxis in patients with coagulopathy, shock, chronic liver disease, and possibly in neurocritical care patients. They do not specifically recommend prophylaxis in mechanically ventilated patients; this is a controversial recommendation. […] The SCCM/ASHP guidelines equally prefer proton pump inhibitor (PPI) and histamine-2 receptor antagonists (H2RA) drug therapies given either intravenously or orally. The prophylaxis regimen should be continued until the indication for prophylaxis has resolved or the patient leaves the ICU.

• #30 SCCM and ASHP Guideline for the Prevention of Stress-Related Gastrointestinal Bleeding in Critically Ill Adults | SCCM

  https://www.sccm.org/clinical-resources/guidelines/guidelines/sccm-ashp-guideline-prevention-of-ugib

  We suggest critically ill adults with coagulopathy, shock, or chronic liver disease be considered at risk for clinically important UGIB. Certainty of evidence: Low to moderate […] We suggest clinicians administer enteral nutrition to reduce clinically important stress-related UGIB in critically ill adults compared with no enteral nutrition. Certainty of evidence: Moderate […] We suggest clinicians provide SUP to prevent clinically important UGIB in critically ill adults with risk factors compared with no SUP. Certainty of evidence: Moderate […] We suggest using either PPIs or H2RAs as first-line agents for SUP in critically ill adults with risk factors for clinically important stress-related UGIB compared with no PPIs or H2RAs. Certainty of Evidence: Moderate […] In critically ill adults with risk factors for developing clinically important stress-related UGIB, SUP should be discontinued when the risk factor(s) is no longer present. Discontinuation of SUP prior to transfer out of the ICU is necessary to prevent inappropriate prescribing.

• #31 Stress ulcer – Wikipedia

  https://en.wikipedia.org/wiki/Stress_ulcer

  The need for medications to prevent stress ulcer among those in the intensive care unit is unclear. As of 2014, the quality of the evidence is poor. […] It is unclear which agent is best or if prevention is needed at all. […] Benefit may only occur in those who are not being fed. […] Possible agents include antacids, H2-receptor blockers, sucralfate, and proton pump inhibitors (PPIs). Tentative evidence supports that PPIs may be better than H2 blockers. […] Concerns with the use of stress ulcer prophylaxis agents include increased rates of pneumonia and Clostridioides difficile colitis.

• #32 Stress Ulcer Prophylaxis: The Consequences of Overuse and Misuse

  https://www.uspharmacist.com/article/stress-ulcer-prophylaxis-the-consequences-of-overuse-and-misuse

  It seems as though almost every patient admitted to the hospital in the United States is prescribed either a proton pump inhibitor (PPI) or a histamine-2 antagonist (H2A) as stress ulcer prophylaxis (SUP). […] Although proven to be highly effective in reducing the risk of both overt and clinically important stress-related mucosal bleeding, prophylactic therapy alone does not decrease the overall mortality rate. […] The overuse and misuse of ASDs may result in patient harm and increased costs for the health care system. […] In light of these statistics, SUP continues to be overprescribed. […] The American Society of Health-System Pharmacists has developed one of the most comprehensive evidence-based guidelines for SUP. […] SUP is not recommended for non-ICU patients; prophylaxis is recommended only for ICU patients who require mechanical ventilation for more than 48 hours, have a history of GI ulceration or bleeding within 1 year before admission, or who have coagulopathy.

• #33

• #34 Episode 932: Major Developments in Stress Ulcer Prophylaxis Evidence – Pharmacy Joe –

  https://pharmacyjoe.com/episode932/

  The use of acid-suppressing agents to prevent the development of stress ulcers has been an area of intense research as the exact benefits and harms of this strategy in the context of modern ICU care is uncertain. […] Among patients undergoing invasive ventilation, pantoprazole resulted in a significantly lower risk of clinically important upper gastrointestinal bleeding than placebo, with no significant effect on mortality. […] This meta analysis included 12 trials and nearly 10000 patients. There was high certainty that proton-pump inhibitors were associated with a reduced incidence of clinically important upper gastrointestinal bleeding with a relative risk ratio of 0.51. […] The expert concludes they will prescribe prophylactic proton-pump inhibitors to patients during mechanical ventilation if they have an APACHE II score of less than 25 as a measure of less critically ill patients.

• #35 Peptic Ulcer Disease: Background, Anatomy, Pathophysiology

  https://emedicine.medscape.com/article/181753-overview

  Most patients with peptic ulcer disease are treated successfully with cure of H pylori infection and/or avoidance of nonsteroidal anti-inflammatory drugs (NSAIDs), along with the appropriate use of antisecretory therapy. In patients with NSAID-associated peptic ulcers, discontinuation of NSAIDs is paramount, if it is clinically feasible. For patients who must continue with their NSAIDs, proton pump inhibitor (PPI) maintenance is recommended to prevent recurrences even after eradication of H pylori. Prophylactic regimens that have been shown to dramatically reduce the risk of NSAID-induced gastric and duodenal ulcers include the use of a prostaglandin analog or a PPI. Maintenance therapy with antisecretory medications (eg, H2 blockers, PPIs) for 1 year is indicated in high-risk patients. […] A long-term prospective study found that patients with arthritis who were older than 65 years who regularly took low-dose aspirin were at an increased risk for dyspepsia severe enough to necessitate the discontinuation of NSAIDs.

• #36 Prevention of peptic ulcers with esomeprazole in patients at risk of ulcer development treated with low-dose acetylsalicylic acid: a randomised, controlled trial (OBERON) | Heart

  https://heart.bmj.com/content/97/10/797

  In the OBERON trial, once-daily esomeprazole 40mg and 20mg significantly reduced the incidence of endoscopy-confirmed peptic ulcer, compared with placebo, during 26weeks of treatment. […] The results of the OBERON trial demonstrate that esomeprazole 40mg and 20mg once daily reduces the risk of endoscopically proved peptic ulcer in patients who take low-dose ASA, and who are at risk for ulcer development.

• #37 Causes, Treatment and Prevention of Peptic Ulcers

  https://hunterdongastro.com/peptic-ulcers/

  Peptic ulcers can be caused by a variety of factors. […] Keep in mind that smoking and drinking alcohol can make your body more prone to developing ulcers by irritating the stomach and decreasing your immunity. […] To reduce your risk of developing a peptic ulcer: Avoid tobacco products, Avoid alcohol, Use caution with aspirin and/or NSAIDs, Don’t ignore your ulcer symptoms, Protect yourself from infections by washing hands regularly and consuming foods that have been cooked thoroughly.

• #38 Ulcers Facts: Causes, Symptoms, Risk Factors

  https://www.webmd.com/digestive-disorders/understanding-ulcers-basic-information

  Don’t smoke, and limit alcohol. These two habits make you more likely to get peptic ulcers. […] Manage stress. Stress can make the symptoms of a peptic ulcer worse. […] Consider probiotics. […] Prevent H. pylori infection. […] You can also do some things to make an H. pylori infection less likely:

• #39 Trends in Hospitalizations for Peptic Ulcer Disease, United States, 1998–2005 – Volume 16, Number 9—September 2010 – Emerging Infectious Diseases journal – CDC

  https://wwwnc.cdc.gov/eid/article/16/9/09-1126_article

  Infection with Helicobacter pylori increases the risk for peptic ulcer disease (PUD) and its complications. […] Appropriate antimicrobial drug regimens to eradicate the infection and cure ulcers have been available since Marshall and Warren discovered H. pylori as an etiologic agent of ulcers in the early 1980s. Eradicating these infections prevents recurrence and ulcer complications such as bleeding or perforation. […] The goals of the campaign were to promote the increased use of appropriate antimicrobial drug treatment to eradicate H. pylori, which would thus lead to a further decline in rates of hospitalization for PUD and its complications. […] To facilitate further declines in hospitalizations for PUD, patients and clinicians should continue to be educated about the association between H. pylori and PUD.

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