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Study provides guidance for use of acid-suppressive medications in hospital patients
Date:1/7/2013

BOSTON -- Critically ill patients in hospital intensive care units (ICUs) are routinely prescribed acid-suppressive medications to reduce their risk of developing stress ulcers and gastrointestinal bleeding, both of which can result from being in a stressful environment and from being intubated. Over the years, this routine practice has often been extended to patients outside the ICU, despite a lack of evidence that this population is at significant risk of these complications.

Now a study led by investigators at Beth Israel Deaconess Medical Center (BIDMC) describes a new scoring system to help clinicians better identify non-ICU hospital patients who are at risk for GI bleeding. Appearing in the Journal of General Internal Medicine, the new findings could help doctors to selectively use acid-suppressive medications when needed and avoid using them when there is no indication that patients are at risk thereby saving costs and avoiding the medications' sometimes serious side effects.

"Current guidelines recommend against the routine use of acid-suppressive medication to prevent stress ulcers in non-ICU patients. Moreover, there is growing evidence that these drugs are associated with an increased risk of complications, including hospital-acquired pneumonia and clostridium difficile," explains first author Shoshana Herzig, MD, an investigator in BIDMC's Division of General Medicine and Primary Care and Instructor in Medicine at Harvard Medical School. "Despite these factors, acid-suppressive medications continue to be used indiscriminately in non-ICU patients."

However, she adds, eliminating their use altogether is not the answer. "It would be preferable to target use of these medications to patients who need them most. We had observed that there was a lack of evidence to guide physicians in prescribing acid-suppressive medications for stress ulcer prophylaxis in patients outside the ICU. Our goal was to provide data that mig
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Contact: Bonnie Prescott
bprescot@bidmc.harvard.edu
617-667-7306
Beth Israel Deaconess Medical Center
Source:Eurekalert

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