# Variations in Stress Ulcer Prophylaxis Practices Among Intensive Care Units in Makkah City Hospitals, Kingdom of Saudi Arabia

## TL;DR

This study examines how ICU doctors in Makkah City use stress ulcer prophylaxis and finds significant differences in practice despite awareness of guidelines.

## Contribution

The study identifies local variations in stress ulcer prophylaxis practices and barriers to guideline adherence among ICU physicians in Saudi Arabia.

## Key findings

- Most ICU physicians are familiar with stress ulcer prophylaxis guidelines, but practice varies significantly.
- Intravenous proton pump inhibitors are the most commonly used prophylactic agents.
- Lack of standardized protocols and limited pharmacist support are major barriers to consistent practice.

## Abstract

Introduction

Stress-related mucosal disease (SRMD) encompasses a spectrum of gastric mucosal injuries, ranging from superficial erosions to deep ulcerations, typically occurring in critically ill patients due to mucosal ischemia and impaired protective mechanisms. It is a frequent and serious complication among patients in intensive care units (ICUs), with stress ulcer prophylaxis (SUP) widely used to reduce the risk of gastrointestinal (GI) bleeding. However, inappropriate use of SUP can expose patients to avoidable risks, including ventilator-associated pneumonia and Clostridium difficile infections. Despite the availability of international guidelines, variations in SUP practices persist across healthcare settings. This study aimed to identify the current local practice of SUP use and to evaluate awareness of international guidelines and associated challenges among ICU physicians in Makkah City hospitals, Saudi Arabia.

Methods

This cross-sectional study was conducted from July to September 2024 among 92 ICU physicians working in adult intensive care units across Makkah city hospitals, Saudi Arabia. Physicians with more than three months of ICU experience who were involved in stress ulcer prophylaxis management were included, while those with less experience or working exclusively in pediatric/neonatal ICUs were excluded. Data were collected via a validated electronic questionnaire assessing SUP practices and awareness of related guidelines and complications. Statistical analysis was performed using IBM Corp. Released 2017. IBM SPSS Statistics for Windows, Version 26.0. Armonk, NY: IBM Corp. Ethical approval and informed consent were obtained.

Results

A total of 92 ICU physicians participated in the survey. Most respondents, 83 (90%), reported familiarity with stress ulcer prophylaxis (SUP) guidelines. Timing and indications for initiating SUP varied, with 45 physicians (48%) initiating it based on major risk factors, while 28 (31%) supported its use even in the absence of clear risk factors. Sixty-two physicians (67%) endorsed universal SUP use, whereas 30 (33%) preferred selective administration. Intravenous proton pump inhibitors (PPIs) were the preferred agent among 73 participants (79.1%). Reported barriers to consistent SUP practice included the lack of daily medication reviews, cited by 59 participants (63.7%), and limited pharmacist support, noted by 36 participants (39.6%). Most participants, 57 (48%), indicated that SUP decisions were made individually by ICU physicians rather than through standardized protocols.

Conclusion

Despite high awareness of SUP guidelines, considerable variability in practice persists among ICU physicians in Makkah City. Standardized protocols, enhanced pharmacist involvement, and targeted educational initiatives are essential to promote evidence-based SUP use and minimize associated risks.