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To our knowledge, the incidence of nosocomial GI bleeding and the effect of acid-suppressive medication on this complication have not been well examined in a large cohort of noncritically ill patients. 20, 21 Both trials were small, lacked double blinding, did not evaluate proton pump inhibitors, and were restricted to patients with very severe illness and presumed risk factors for stress ulceration, limiting their generalizability to the average inpatient receiving acid-suppressive medication outside of the ICU. Two randomized controlled trials have evaluated the effect of acid-suppressive medications on GI bleeding outside of the ICU. 1 In this context, balancing the risks and benefits of acid-suppressive medication in hospitalized patients requires a better understanding of possible benefits of these medications, particularly potential reductions in the competing risk of nosocomial GI bleeding. In addition to the financial cost incurred by this practice, several recent studies have demonstrated increased risks of infection associated with use of acid-suppressive medication in hospitalized patients, including Clostridium difficile infection 17 - 19 and hospital-acquired pneumonia. 9 - 15 While current guidelines recommend against the routine use of prophylactic acid suppression in patients outside of the intensive care unit (ICU), 16 this recommendation is based on expert consensus there are little data available on the incidence of nosocomial GI bleeding in the non-ICU population and whether these patients would benefit from acid-suppressive medication. 4 - 8 This practice appears to have stemmed from the use of acid suppression to prevent stress-related gastrointestinal (GI) tract bleeding (GI bleeding) in critically ill patients, where the incidence of nosocomial GI bleeding and the effect of acid-suppressive medication have been well characterized. 1 - 3 Although some of these patients have clear indications for acid suppression, research has consistently found that most do not.

Studies estimate that 40% to 70% of medical inpatients receive acid-suppressive medications during their hospitalization. The use of acid-suppressive medication in hospitalized patients has increased significantly over the last several decades.