An Updated Review and a Case Report: Stress Ulcer Prophylaxis

TL;DR

This paper reviews stress ulcer prophylaxis through a patient case and updated literature, highlighting its risks, benefits, and appropriate use.

Contribution

The paper provides an updated analysis of stress ulcer prophylaxis, emphasizing its overuse and adverse effects in noncritical patients.

Findings

Stress ulcer prophylaxis has mixed effectiveness in noncritical patients.

Inappropriate use leads to adverse effects like dysbiosis and pneumonia.

Early enteral nutrition is a viable alternative to prevent stress ulcers.

Abstract

After encountering a unique patient case, we revisit the updated literature on stress ulcer prophylaxis with more updated studies. A 47-year-old male came to the hospital and was found to have acute cholecystitis. After undergoing urgent cholecystectomy, the patient developed melena and a 6 mg/dL drop from 12.5 g/dL to 6.5 g/dL in hemoglobin. He was found to have a gastric ulcer and was started on a proton pump inhibitor, which posed the question of whether or not stress ulcer prophylaxis was indicated. Therefore, the pathophysiology of stress ulcer prophylaxis is refreshed, discussing the various mechanisms through which stress ulcers form in a clinical context. Then, the main risk factors and indications for stress ulcer prophylaxis are defined based on current literature, further investigating whether or not stress ulcer prophylaxis has shown benefit and protection in various patient groups. Additionally, this review discusses the adverse effects of stress ulcer prophylaxis, including dysbiosis, community-acquired pneumonia, nutritional deficiencies, drug interactions, and fractures. Finally, inappropriate stress ulcer prophylaxis and contributing factors to overutilization are discussed, and alternative approaches to prevent stress ulcer formation are covered, including early enteral nutrition. Overall, there are mixed conclusions on the effectiveness of stress ulcer prophylaxis in noncritical patients. There are many adverse effects and unnecessary costs associated with inappropriate administration, and many studies have found that it should be reserved for specific clinical indications.