STRESS-ULCER PROPHYLAXIS IN MEDICAL ICU PATIENTS - ANNUAL UTILIZATIONIN RELATION TO THE INCIDENCE OF ENDOSCOPICALLY PROVEN STRESS ULCERATION

OBJECTIVE: To measure changes in the proportion of medical intensive c are unit (MICU) patients prescribed pharmacologic stress ulcer prophyl axis therapy over a it-year period in relation to the incidence of str ess-related ulceration detected by endoscopy at our institution. DESIG N: Retrospective 4-year review of pharmacy and endoscopy databases. SE TTING: A 35-bed MICU. PATIENTS: Patients (n = 2941) admitted to the MI CU for longer than 24 hours, between January 1, 1993, and December 31, 1996, without acute gastrointestinal hemorrhage on admission. METHODS : Records were reviewed to identify patients prescribed pharmacologic stress ulcer prophylaxis (>24 h of sucralfate or a histamine(2)-recept or antagonist [H(2)RA]), and patients with evidence of stress ulcerati on during endoscopy. RESULTS: The number of patients per year receivin g stress ulcer prophylaxis significantly (p < 0.001) decreased between 1993 and 1996:1993, 492/693 (71%); 1994, 478/798 (60%) 1995, 295/670 (44%); 1996, 164/780 (21%). There was no difference between years in t he median duration of stress ulcer prophylaxis therapy or the proporti on of patients receiving sucralfate versus H(2)RA therapy. There was n o difference (p = 0.91) between years in the annual incidence of defin ite or possible stress-related ulceration: 1993, 6/693 (0.87%); 1994, 5/798 (0.63%); 1995, 6/670 (0.90%); 1996, 5/780 (0.64%). CONCLUSIONS: The incidence of endoscopically proven stress-related ulceration has r emained unchanged over the past 4 years in our MICU despite significan tly fewer patients receiving pharmacologic stress ulcer prophylaxis th erapy.