Choosing Wisely:

Don’t continue hospital-prescribed stress ulcer prophylaxis with proton pump inhibitor therapy in the absence of an appropriate diagnosis in the post-acute and long-term care population.

Rationale and Comments: In the absence of an appropriate diagnosis for the long-term use of proton pump inhibitors in post-acute and long-term care populations, stop hospital-prescribed medications for stress prophylaxis, as literature does not support proton pump inhibitor use for stress ulcer prophylaxis outside the ICU setting. It is important to determine the indication for use and balance potential harm versus benefit, recognizing known adverse events with long-term proton pump inhibitor use, including pneumonia, diminished vitamin absorption, and bacterial infections such as Clostridium difficile.
Sponsoring Organizations:
  • Society for Post-Acute and Long-Term Care Medicine
  • Sources:
  • Expert consensus
  • Disciplines:
  • Geriatric Medicine
  • Gastroenterologic
  • References: • Wilsdon TD, et al. Effectiveness of interventions to deprescribe inappropriate proton pump inhibitors in older adults. Drugs Aging. 2017;34(4):265-287.
    • Ito T, et al. Association of long-term proton pump inhibitor therapy with bone fractures and effects on absorption of calcium, vitamin B12, iron, and magnesium. Curr Gastroenterol Rep. 2010;12(6):448-457.
    • Wilhelm SM, et al. Perils and pitfalls of long-term effects of proton pump inhibitors. Expert Rev Clin Pharmacol. 2013;6(4):443-451.
    • Johnson DA, et al. Reported side effects and complications of long-term proton pump inhibitor use: dissecting the evidence. Clin Gastroenterol Hepatol. 2013;11(5):458-464; quiz e37-e38.

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