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

Study Questions:

What is the incidence of nosocomial gastrointestinal (GI) bleeding outside of the intensive care unit and the association between acid-suppressive medication use and this complication?

Methods:

The investigators conducted a pharmacoepidemiologic cohort study of patients admitted to an academic medical center from 2004 through 2007, at least 18 years of age, and hospitalized for 3 or more days. Admissions with a primary diagnosis of GI bleeding were excluded. Acid-suppressive medication use was defined as any order for a proton pump inhibitor or histamine-2-receptor antagonist. The main outcome measure was nosocomial GI bleeding. A propensity-matched generalized estimating equation was used to control for confounders.

Results:

The final cohort included 78,394 admissions (median age, 56 years; 41% men). Acid-suppressive medication was ordered in 59% of admissions, and nosocomial GI bleeding occurred in 224 admissions (0.29%). After matching on the propensity score, the adjusted odds ratio for nosocomial GI bleeding in the group exposed to acid-suppressive medication relative to the unexposed group was 0.63 (95% confidence interval, 0.42-0.93). The number needed to treat (NNT) to prevent one episode of nosocomial GI bleeding was 770.

Conclusions:

The authors concluded that despite a protective effect of acid-suppressive medication, the NNT to prevent one case of nosocomial GI bleeding was relatively high.

Perspective:

The study suggests that in a large cohort of noncritically ill hospitalized patients, nosocomial GI bleeding was quite rare. Acid-suppressive medication use was associated with decreased odds of nosocomial GI bleeding; however, the NNT to prevent one case of GI bleeding was high at 730. Clinicians need to balance the effectiveness of these medications against their cost and their associated risks. Overall, these findings support the current recommendations against routine use of prophylactic acid-suppressive medication in noncritically ill hospitalized patients.

Clinical Topics: Heart Failure and Cardiomyopathies

Keywords: Outcome Assessment (Health Care), Risk, Histamine H2 Antagonists, Gastrointestinal Tract, Proton Pump Inhibitors


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