Acid-Suppressive Medication Use and the Risk for Nosocomial Gastrointestinal Tract Bleeding

An estimated 40 percent to 70 percent of hospitalized patients receive acid-suppressive medications during their stay. While some have clear indications for needing the medication, most do not. The prophylactic acid-suppression medication is intended to prevent stress-related gastrointestinal (GI) tract bleeding, even though guidelines recommend against it for patients not in the intensive care unit (ICU). The incidence of nosocomial gastrointestinal bleeding and the effect of acid-suppressive medication has not been studied in non-ICU patients.

The researchers examined nearly 80,000 admissions to a Boston academic medical center over four years. Acid-suppressive medication was ordered in 59 percent of the admissions. Researchers matched patients who received acid-suppressive medication with the same number who did not. They found that nosocomial GI bleeding outside the ICU occurred in only .29 percent of admissions. Some 770 patients would need to be treated with acid-suppressive medication to prevent one episode of nosocomial GI bleeding.

Clinicians need to carefully balance the effectiveness of acid-suppressive medication against the costs and the associated increased risk of infection, including pneumonia.

"Our findings support the current recommendations against routine use of prophylactic acid-suppressive medication in patients outside of the ICU," the researchers conclude.