Risk factors for stress ulcers and stress ulcer prophylaxis

Stress ulcer prophylaxis is a topic that comes up frequently on the internal medicine service but is not frequently given more than a moment of consideration.  Numerous studies have identified how acid-suppressive therapies (eg. namely proton pump inhibitors and histamine-2 receptor antagonists) are widely prescribed and often lacking an indication.  Studies of various designs have revealed that 46-73% of patients who receive acid-suppressive therapy while hospitalized do not have an indication.^1-3 

The most robust guideline to date for the use of acid-suppressive therapy for stress ulcer prophylaxis was published in 1999 and was comprised of data almost entirely from patients in the intensive care unit (ICU).⁴  At that time, there was only one randomized control trial addressing stress ulcer prophylaxis in the non-ICU setting.  These guidelines identified and determined the weight of various risk factors for the development of stress ulcers and these values are continued to be used today.  The presence or absence or risk factors should be used to determine the need for stress ulcer prophylaxis, not just admission to the ICU.  The summary of recommendations follows below.