Materiały źródłowe

• #1 Prophylaxis and management of stress ulceration – Surgical Treatment – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK6992/

  Prophylaxis […] The high attendant mortality and morbidity associated with the development of bleeding from stress ulceration has resulted in a variety of strategies designed to prevent its occurrence. In spite of eight well-designed meta-analyses directly addressing this question, the ideal prophylactic regimen remains a matter of controversy. […] The choice of a prophylactic regimen has been simplified by the availability of several meta-analyses evaluating the efficacy of different regimens. […] Early enteral nutrition may represent an additional cost-effective strategy for stress ulcer prophylaxis. In one retrospective analysis, early enteral nutrition significantly reduced the incidence of clinically significant stress ulceration.

• #2 Pathophysiology and prophylaxis of stress ulcer in intensive care unit patients – PubMed

  https://pubmed.ncbi.nlm.nih.gov/16015515/

  Gastrointestinal complications frequently occur in patients admitted to the intensive care unit. Of these, ulceration and bleeding related to stress-related mucosal disease (SRMD) can lengthen hospitalization and increase mortality. […] The purpose of this review is to discuss the many risk factors and underlying illnesses that have a role in the pathophysiology of SRMD and evaluate the evidence pertaining to SRMD prophylaxis in the intensive care unit population. Suppressing acid production is fundamental to preventing stress-related mucosal ulceration and clinically important gastrointestinal bleeding. Traditional prophylactic options for SRMD in critically ill patients include antacids, sucralfate, histamine 2-receptor antagonists (H 2 RAs), and proton pump inhibitors. Many clinicians prescribe intermittent infusions of H 2 RAs for stress ulcer prophylaxis, a practice that has not been approved for this indication and may not provide the necessary degree or duration of acid suppression required to prevent stress ulcer-related bleeding. New data suggest that proton pump inhibitors suppress acid production more completely in critically ill patients, but more studies are required to assess their clinical effectiveness and safety for this indication. The prophylactic regimen chosen to prevent stress ulcer bleeding should take into account the risk factors and underlying disease state of individual patients to provide the best therapy to those most likely to benefit.

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

  http://www.medletter.com/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. After 6 months, the incidence of ulcers seen at endoscopy was 3.6% in the patients on omeprazole and 16.5% in those on placebo.

• #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 need an NSAID, you also may need to take other medicines to help protect your stomach. These include antacids, proton pump inhibitors, acid blockers or cytoprotective agents. […] 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 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. Acetaminophen (paracetamol) may sometimes be an alternative to NSAIDs. It doesn’t increase the risk of peptic ulcers and is often just as effective. […] 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.

• #5 Preventing peptic ulcers | informedhealth.org

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

  The long-term use of painkillers like diclofenac or ibuprofen can lead to ulcers in the stomach or duodenum (peptic ulcers). But the risk of this happening can be clearly reduced by also taking medication to protect your stomach. […] Various medications can lower the risk of getting a peptic ulcer. These include, in particular, drugs called proton pump inhibitors (PPIs) and H2 blockers. Both of these types of drugs reduce the production of stomach acid. […] Not everyone who regularly takes NSAIDs will also need to take medication to protect their stomach. This will mainly depend on your personal risk of developing an ulcer. […] Younger people who don’t have any risk factors aren’t likely to get peptic ulcers. So they hardly benefit from taking medication to prevent 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.

• #6 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.

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

  http://www.medletter.com/TML-article-1333b

  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. […] 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.

• #8 Peptic ulcer Information | Mount Sinai – New York

  https://www.mountsinai.org/health-library/condition/peptic-ulcer

  Preventing NSAID-related ulcers means finding different medications or alternative approaches to relieve your pain. Talk to your doctor about your options. If you have to take NSAIDs for a long time, your doctor may consider prescribing another medication to prevent the development of ulcers. This medicine may include an H2 blocker or a proton pump inhibitor, which reduce stomach acid. […] You can also make lifestyle changes that make you less prone to develop an ulcer from either NSAIDs or H. pylori.

• #9

  https://www.nhs.uk/conditions/stomach-ulcer/treatment/

  There aren’t any special lifestyle measures you need to take during treatment, but avoiding stress, alcohol, spicy foods and smoking may reduce your symptoms while your ulcer heals. […] If your stomach ulcer has been caused by taking NSAIDs, your GP will want to review your use of them. […] Sometimes an alternative type of NSAID that’s less likely to cause stomach ulcers, called a COX-2 inhibitor, may be recommended. […] If you do need to keep taking it, long-term treatment with a PPI or H2-receptor antagonist may be prescribed alongside the aspirin to try to prevent further ulcers. […] It’s important to understand the potential risks associated with continued NSAID use. […] You’re more likely to develop another stomach ulcer and could experience a serious complication, such as internal bleeding.

• #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 Stomach Ulcer: Signs, Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/22314-stomach-ulcer

  To prevent a stomach ulcer, take steps to: […] Eliminate H. pylori. Most people who have H. pylori infection aren’t aware of it. You can find out if you have it by taking a simple breath test or stool test. If you do, you can treat it proactively (before it causes any problems). […] Use NSAIDs 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 take them for medical reasons, talk to your provider about reducing your dosage, switching your medication or taking other medications with them to protect your stomach lining. […] Reduce other irritants. Smoking, alcohol use and certain other medications can make ulcers more likely if you also have H. pylori or take NSAIDs.

• #12 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 arent 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 youve had it and treated it before, its a good idea to retest because sometimes it comes back. […] Use NSAIDs only as directed. If youre in the habit of managing daily aches and pains with NSAIDs, make sure you arent taking more than the recommended dose. If youve already had peptic ulcer disease, you probably shouldnt take them at all. But if you have to, you should take them with another medication to protect your lining.

• #13 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. […] 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.

• #14 Stomach Ulcer: Causes, Symptoms, and Diagnosis

  https://www.healthline.com/health/stomach-ulcer

  The best way to help prevent stomach ulcers is to limit your intake of NSAIDs and take measures to prevent contracting H. pylori. This may include: […] washing your hands regularly […] preventing cross-contamination of foods […] properly cooking and storing foods, especially meat and seafood. […] If you need to take NSAIDs, be sure to follow the recommended dosage and guidance from your doctor.

• #15 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.

• #16 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.

• #17 Which ICU patients need stress ulcer prophylaxis? | Cleveland Clinic Journal of Medicine

  https://www.ccjm.org/content/89/7/363

  Critically ill patients are at an increased risk for developing stress ulcers of the mucosa of the upper gastrointestinal (GI) tract. […] Thus, most patients admitted to the intensive care unit receive stress ulcer prophylaxis. […] Although stress ulcer prophylaxis has not been shown to reduce mortality risk, it decreases the risk of clinically significant bleeding and does not increase risk of C difficile infection or pneumonia. […] The beneficial effects of stress ulcer prophylaxis on GI bleeding argue for its use in critically ill patients with risk factors for developing stress ulcers. […] Stress ulcer prophylaxis does not reduce mortality rates. But on the other hand, it decreases the risk of clinically significant bleeding and does not increase the risk of C difficile infection or pneumonia. Based on these findings, we believe that prophylaxis should be considered in critically ill patients with risk factors for stress ulcers. Frequent reassessment and de-escalation of therapy are warranted when the patient is at lower risk for bleeding.

• #18 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).

• #19 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 [the intervention is recommended selectively based upon professional judgment and patient preferences. There is at least moderate certainty that the net benefit is small]). […] 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). […] At the onset of risk factors. […] Until indication is no longer present or until hospital discharge. […] 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).

• #20 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.

• #21 Stress Ulcer Prophylaxis

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

  H2-receptor antagonists are commonly used and have shown similar efficacy in preventing clinically significant GI bleeding. However, 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.

• #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 suggests that the benefits of SUP outweigh the risks. […] 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 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.

• #24 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. […] 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. The current therapeutic guidelines were published in 1999, with an update in progress at this writing. 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. Prophylaxis is also advised for ICU patients with at least two of the following risk factors: sepsis, ICU stay exceeding 1 week, occult bleeding lasting 6 days or more, and the use of high-dose corticosteroids (hydrocortisone 250 mg/day or equivalent).

• #25 Stress Ulcer Prophylaxis Within the ICU

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

  Additionally, recent data hint at a potential reduction in stress ulcers in ICU patients receiving EN. […] Pharmacists play a crucial role in SUP by ensuring the safe and effective use of medications, collaborating with healthcare teams, monitoring patients, and educating them about the importance of adherence. […] In a shifting landscape of SUP, pharmacists remain vital in optimizing patient care.

• #26 Peptic Ulcer: Causes, Treatment, and Prevention

  https://www.healthline.com/health/peptic-ulcer

  Certain lifestyle choices and habits can reduce your risk of developing peptic ulcers. These include: […] Maintaining a healthy lifestyle by quitting smoking cigarettes and other tobacco use and eating a balanced diet rich in fruits, vegetables, and whole grains will help you prevent developing a peptic ulcer.

• #27 Peptic ulcer – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/peptic-ulcer/diagnosis-treatment/drc-20354229

  You may find relief from the pain of a stomach ulcer if you: […] Don’t smoke. Smoking may harm the lining of the stomach, raising the chance of getting an ulcer. Smoking also increases stomach acid. […] Limit or avoid alcohol. Too much alcohol can irritate and eat away the mucous lining in your stomach and intestines. This can cause the lining to inflame and bleed. […] Treatment for refractory ulcers most often involves getting rid of factors that keep the ulcer from healing and trying other antibiotics. If you smoke, your healthcare professional may suggest you quit. Smoking can slow ulcer healing.

• #28 Stomach ulcers: Symptoms, treatment, causes

  https://www.medicalnewstoday.com/articles/312045

  Dietary changes can help prevent stomach ulcers from developing. […] People at risk of stomach ulcers should include more of the following nutrients in their diet: […] Eating a variety of fruit and vegetables is key to a healthy digestive tract lining. These foods are rich in antioxidants, inhibit acid secretion, and contain cytoprotective and anti-inflammatory properties. A 2017 study states that these are all important factors for preventing and treating ulcers. […] Diets high in soluble dietary fiber reduce the risk of developing stomach ulcers. […] Food that contains active bacterial content, such as probiotic yogurt, can help reduce a Helicobacter pylori (H. pylori) infection. […] This powerful antioxidant may be effective in helping eradicate H. pylori, especially when taken in small doses over an extended period.

• #29 Peptic ulcer prevention and diet

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

  Other helpful diet guidelines […] 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. […] The above list is more of a guideline and you may find that some foods that are allowed may aggravate some of your symptoms. Therefore, you should spend time in identifying your individual problem foods and avoid these until your ulcer has completely healed.

• #30 Turmeric shield against gastric ulcers

  https://www.nature.com/articles/nindia.2015.174

  Researchers have discovered that turmeric polysaccharides can alleviate gastric ulcers by protecting the mucus lining of stomach and inhibiting the growth of an ulcer-causing bacterium. […] The modified pectic polysaccharides, which possess multifaceted ulcer-prevention activities, may provide a cost-effective therapeutic option for gastric ulcer, the researchers say.

• #31 Stomach ulcer | Better Health Channel

  https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/stomach-ulcer

  Special diets are now known to have very little impact on the prevention or treatment of stomach ulcers. […] Lifestyle modifications including quitting cigarettes, since smoking reduces the natural defences in the stomach and impairs the healing process. […] Bleeding from stomach ulcers is more common in people treated with blood thinning agents, such as warfarin, aspirin or clopidogrel (Plavix) and those people should also consider using regular anti-ulcer medication to prevent this complication.

• #32 Stomach ulcers: Symptoms, treatment, causes

  https://www.medicalnewstoday.com/articles/312045

  Avoiding alcohol and caffeine can also help reduce the risk, as they both cause the body to produce more gastric acid. This in turn can lead to stomach ulcers. […] However, for the most effective outcome, instead of relying only on a diet, it is important to follow dietary recommendations alongside a treatment plan.

• #33 Risks and benefits of stress ulcer prophylaxis in adult neurocritical care patients: a systematic review and meta-analysis of randomized controlled trials | Critical Care | Full Text

  https://ccforum.biomedcentral.com/articles/10.1186/s13054-015-1107-2

  Neurocritical care patients are at high risk for stress-related upper gastrointestinal (UGI) bleeding. The aim of this meta-analysis was to evaluate the risks and benefits of stress ulcer prophylaxis (SUP) in this patient group. […] SUP was more effective than placebo or no prophylaxis at reducing UGI bleeding and all-cause mortality while not increasing the risk of nosocomial pneumonia. […] Stress ulcer prophylaxis with proton pump inhibitors or histamine 2 receptor antagonists seems to be more effective than placebo or no prophylaxis in reducing the morbidity and mortality of stress-related upper gastrointestinal bleeding in neurocritical care patients. […] Stress ulcer prophylaxis seems to reduce all-cause mortality while not increasing the risk of nosocomial pneumonia in neurocritical care patients. […] The meta-analysis encouraged the use of SUP in neurocritical care patients by providing evidence that SUP with PPIs or H2RAs yields a reduction in stress-related UGI bleeding and all-cause mortality and does not increase the risk of nosocomial pneumonia compared with placebo or no prophylaxis.

• #34 Stress ulcer prophylaxis for critically ill children: routine use needs to be re-examined | Anales de Pediatría

  https://analesdepediatria.org/en-stress-ulcer-prophylaxis-for-critically-articulo-S234128792100034X

  Stress ulcer prophylaxis (SUP) is commonly used in Paediatric Intensive Care Units (PICUs). However, strong evidence for this practice is lacking and there is a dire need for paediatric randomized controlled trials (RCTs). […] In PICU patients with mild to moderate organ dysfunction, omeprazole does not seem to be useful for prevention of gastrointestinal bleeding while at the same time increasing the risk of CLABSI. Thus, we recommend restricting SUP to mechanically ventilated children. […] The previous literature on the usefulness of SUP in critically ill children is limited, and data from randomized controlled trials (RCTs) are scarce. Therefore, the aim of our trial was to evaluate the safety and efficacy of SUP with omeprazole, the agent used most commonly for SUP in critically ill children.

• #35 Stress ulcer prophylaxis for critically ill children: routine use needs to be re-examined | Anales de Pediatría

  https://analesdepediatria.org/en-stress-ulcer-prophylaxis-for-critically-articulo-S234128792100034X

  Until the controversy surrounding the safety of SUP is resolved, it would be more prudent to consider nonpharmacological strategies to prevent bleeding secondary to stress ulcers, such as prompt resuscitation of patients with shock and early initiation of enteral feeding, both of which contribute to maintaining splanchnic blood flow. […] It seems prudent to narrow down the indications for SUP exclusively to patients requiring mechanical ventilation. At the same time, it is clear that larger RCTs are needed to assess the usefulness of SUP in critically ill children more rigorously.

• #36 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.

• #37 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.

• #38 Proton Pump Inhibitors for Stress Ulcer Prophylaxis in Critically Ill Patients – TheNNT

  https://thennt.com/nnt/proton-pump-inhibitors-stress-ulcer-prophylaxis-critically-ill-patients/

  Reduces the risk of clinically significant GI bleeding; do not affect survival […] Prevention of clinically important gastrointestinal bleeding and all-cause mortality […] Overall, this large network meta-analysis found moderate quality evidence that prophylaxis with PPIs or H2RAs reduced clinically important GI bleeding, when compared to no prophylaxis. […] In conclusion, administration of PPIs for stress ulcer prophylaxis in critically ill patients is associated with reduced clinically important upper gastrointestinal bleeding without improving survival.

• #39 Do we still need pharmacological stress ulcer prophylaxis at the ICU? – Buendgens – Journal of Thoracic Disease

  https://jtd.amegroups.org/article/view/16635/html

  Besides other effects, enteral nutrition promotes mesenteric perfusion and protects the gastric and intestinal mucosa in critically ill patients. […] Accordingly, retrospective studies found no benefit for pharmacological gastric ulcer prophylaxis in enterally fed patients. […] While several older trials could demonstrate a reduction in bleeding incidence in patients receiving pharmacological stress ulcer prophylaxis, none could ever connect it to an improved survival. […] Thus, it remains unclear if gastrointestinal bleedings during the course of critical illness are prognostically relevant events per se or epiphenomena of disease severity. […] The administration of a PPI is certainly not a risk-free prophylactic intervention, and we are only starting to apprehend some of the changes that they provoke in the intestinal microbiome and other anti-infective defense mechanisms of the body.

• #40 Don’t prescribe medications for stress ulcer prophylaxis to medical inpatients unless at high risk for gastrointestinal complications. | AAFP

  https://www.aafp.org/pubs/afp/collections/choosing-wisely/22.html

  According to published guidelines, medications for stress ulcer prophylaxis are not recommended for adult patients in non-intensive care unit settings. […] Adherence to therapeutic guidelines will aid health care providers in reducing treatment of patients without clinically important risk factors for gastrointestinal bleeding.

• #41

  https://link.springer.com/article/10.1007/s00423-021-02325-3

  Stress ulcer prophylaxis (SUP) has been a widespread practice both in intensive care units (ICU) and internal wards at the beginning of the twenty-first century. […] Still today, SUP is widely overused in non-ICU surgical patients. Information campaigns on risk factors for stress ulcer development and standard operating procedures for SUP are required to limit potential side effects and increased treatment costs. […] The present work addresses the question whether more than 30 years of ongoing controversy on the adequacy of SUP in this patient population has elicited a modification of clinical practice in the Department of General Surgery, Visceral, Thoracic and Vascular Surgery of the University Medical Centre in the north of Germany. […] Among the patients admitted without pre-existing ASM, 40.3% received SUP de novo.

• #42 Prophylaxis for stress ulcer bleeding in the intensive care unit | Revista de Gastroenterología de México

  https://www.revistagastroenterologiamexico.org/en-prophylaxis-for-stress-ulcer-bleeding-articulo-S2255534X14000334

  The critically ill patient can develop gastric erosions and, on occasion, stress ulcers with severe gastrointestinal bleeding that can be fatal. […] The purpose of this review was to provide current information on the pathophysiology, risk factors, and prophylaxis of digestive tract bleeding from stress ulcers in the intensive care unit. […] Proton pump inhibitors (PPIs) or H2 receptor antagonists (H2RAs) are used in stress ulcer bleeding prophylaxis. Both drugs have been shown to be superior to placebo in reducing the risk for gastrointestinal bleeding and PPIs are at least as effective as H2RAs. […] Admittance to the intensive care unit in itself does not justify prophylaxis. […] We should individualize the treatment of each patient in the intensive care unit, determining risk and evaluating the need to begin prophylaxis.

• #43 Prophylaxis for stress ulcer bleeding in the intensive care unit | Revista de Gastroenterología de México

  https://www.revistagastroenterologiamexico.org/en-prophylaxis-for-stress-ulcer-bleeding-articulo-S2255534X14000334

  Only patients with respiratory failure requiring mechanical ventilation for more than 48h and those with coagulopathy, head injury, and severe burns are at significant risk for such bleeding and are likely to benefit from prophylaxis. […] The most appropriate prophylactic agent to prevent stress-related bleeding remains to be determined. […] Currently, most ICUs are using PPIs instead of H2RAs as stress ulcer prophylactic agents. […] Early enteral feeding had been postulated as a useful tool in preventing stress-related gastrointestinal bleeding. […] Therefore, it has been suggested that early enteral feeding would be beneficial in preventing UGI bleeding secondary to stress-related mucosal disease. […] The results of this meta-analysis suggest that in patients receiving enteral tube feeding, stress ulcer prophylaxis may not be required, and indeed, it could increase the risk of complications.

• #44 Peptic ulcers: Symptoms, causes, and treatments

  https://www.medicalnewstoday.com/articles/9273

  People may not be able to prevent all ulcers from forming. […] However, they can limit their use of NSAIDs to help prevent new ulcers from forming. People with chronic pain conditions can talk with their doctor about alternatives to NSAIDs that may be safer for their stomachs. […] Another step to help prevent ulcers is to finish a full antibiotic regimen. People should see their doctor for a follow-up to ensure the bacteria is under control.

• #45 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. […] Nonpharmacological measures: e.g., avoid NSAIDs, restrict alcohol. […] 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). […] 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. […] Always use the lowest possible effective dose of an NSAID. […] Generally, prescribe a PPI for patients on low-dose aspirin who have at least one other risk factor for NSAID-induced GI toxicity (e.g., currently taking another NSAID or antithrombotic).

• #46 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.

• #47 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.

• #48

  https://link.springer.com/article/10.1007/s00134-024-07674-3

  Gastric or duodenal mucosal erosions, or stress ulcers, are a known complication of critical illness. General supportive care and treatment of the underlying cause of the critical illness are the cornerstones of intensive care medicine and may help minimize the risk of stress ulcer bleeding. Stress ulcer prophylaxis is often prescribed to prevent such ulcers and their consequences which include patient and family concerns, tests (e.g., endoscopy), treatments (e.g., blood transfusions), and associated morbidity and mortality. […] Proton pump inhibitors (PPIs) are the mainstay of stress ulcer prophylaxis. […] Stress ulcer prophylaxis has been incorporated into intensive care unit (ICU) admission order sets, checklists and guidelines. […] Permanent prescription of stress ulcer prophylaxis beyond ICU without clear indications is unsupported by trial data.

• #49 Peptic Ulcers | MUSC Health | Charleston SC

  https://muschealth.org/medical-services/ddc/patients/digestive-diseases/stomach-and-duodenum/peptic-ulcers

  At present there is no good evidence that widespread antibiotic therapy to eradicate helicobacter pylori in the population will prevent ulcer disease. […] Careful use of aspirin and other NSAIDs, as well as avoidance by people at high risk of complications, is also recommended. Stopping smoking may also reduce the chances of developing and ulcer. […] Important steps in management of peptic ulcers include: stopping smoking; curtailing excessive alcohol intake; and, avoiding aspirin and other NSAIDs, if possible.

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

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

  Efforts by clinicians to curb the use of ASDs in non-ICU patients can prevent significant patient morbidity and reduce both hospital costs and costs to the overall health care system. It is important to carefully weigh the risks and benefits of ASDs before using these medications in the inpatient setting. Special consideration should be given to patients already at risk for pneumonia, such as the elderly, those with chronic lung disease, and those taking immunosuppressants. Every effort should be made to critically assess acid-suppression therapy in inpatients and to discontinue therapy whenever possible. When SUP is indicated, the patient should receive the lowest dose possible.

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