Use of Acid Suppression Agents following Acute, Nonvariceal, Upper Gastrointestinal Bleeding

Abstract

Purpose This study evaluated the utilization of acid suppression agents following upper gastrointestinal (GI) bleeding in the state of Michigan. Methods A focus group was used to develop a one-page survey that consisted of questions pertaining to acid suppression agents following acute, upper GI bleeding. Survey consistency and validity were established through review by several experienced pharmacists practicing in either critical care or drug information. Surveys were mailed twice (at 30-day intervals) to the director of pharmacy at all hospitals (n = 267) in the state of Michigan. Results Completed surveys were received from 76/267 (28.5%) institutions. Sixty-five percent of institutions stated that they had one preferred intravenous (IV) acid suppressive agent for acute GI bleeding, with 59% using a histamine-2 receptor antagonist (H2RA) and 41% using a proton pump inhibitor (PPI). When an IV PPI was prescribed, only 36% used a continuous infusion dosing regimen. For IV to oral step-down therapy, PPIs were chosen more often than H2RAs (81% vs 19%). Oral PPI therapy was usually initiated using a capsule/tablet (82%) as opposed to a PPI suspension (18%). Institutional guidelines for acid suppression were in place at only 23% of institutions, although 67% had restrictions for IV PPI use. Conclusion Wide variation exists in the use of acid suppressive agents following upper GI bleeding in the state of Michigan.