Acid suppressive therapy use on an inpatient internal medicine service

BACKGROUND: Use of acid suppressant medications has increased in both frequency and breadth in recent years. Data have indicated that questionable use of acid suppressants for non-accepted indications is common. OBJECTIVE: To assess the indications and prevalence of acid suppressants used by inpatients on admission and at discharge. METHODS: A retrospective chart review of 213 patients admitted to the University of Michigan Hospital non-critical care general medical service was conducted. Relevant medical history, acid suppressant drug used, and indications were collected from both inpatient medical records and discharge medication lists. RESULTS: Of the 213 patients reviewed, 29% were taking acid suppressants prior to admission, with 33% being proton pump inhibitors (PPIs). Once patients were admitted, acid suppressant use increased to 71% (152 of 213), with 84% PPIs, 11% histamine(2)-receptor antagonists, and 5% combination therapy. Based upon our criteria, only 10% (15 of 152) of those on acid suppressants were found to have an acceptable indication. In patients where any history of gastroesophageal reflux disorder (GERD) was deemed as an acceptable indication (32 other patients), 31% (47 of 152) had an acceptable indication. For the 137 patients with non-accepted indications, 29% had no discernable indication and 38% were prescribed acid suppressants for corticosteroid-associated or stress ulcer prophylaxis. A history of gastrointestinal bleeds or peptic ulcer disease of more than 3 months since initial diagnosis or documented exacerbation of symptoms comprised 8% of the population. The aforementioned group of GERD patients made up 23% of this group. Compared to the 29% of patients taking acid suppressants prior to admission, 54% (115 of 213) of patients were prescribed acid suppressants at discharge. If only recent exacerbations of GERD were deemed as long-term indications, 10% (112 of 115) of these patients were found to have accepted indications. If all GERDs were acceptable long-term indications, 27% (31 of 115) would have met criteria for acceptable outpatient use. CONCLUSIONS: There is considerable excess usage of acid suppressants in both the inpatient and outpatient settings.