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INTRODUCTION:Upper gastrointestinal stress ulcer formation is a potential risk for critically ill hospitalized patients. Due to this, SUP is an important preventative measure for at risk patients. Stress ulcer medications such as PPIs and H2 blockers do come with potential side effects.1,2 A widely accepted guideline was written by the American Society of Health System Pharmacists which along with similar variations continue to be used today.3,4 One such guideline has been implemented within the Ascension Health System (Figure 1). Despite guidelines, inappropriate administration continues to be a common problem. Studies show rates of inappropriate administration anywhere from 20 to 70 percent.5–9 A discrepancy in knowledge from providers leads to inappropriate prescribing of SUP medications. Administration of these laminated cards will improve appropriate administration of the medications.METHODS:Laminated cards were dispersed to fit on ID badges of IM and FP residents which following the Ascension SUP guidelines. Data was collected on all patients admitted under the core faculty of an IM or FP attending between 7/1/18–9/30/18 and 11/1/18–1/31/19. 10/1/19-10/31/19 constituted the run-in period. Patients were excluded if they had active diagnoses of GERD, PUD, H. Pylori. Eligible patients' charts were reviewed at random by using an online number generator. The A&P section of the H&P note was reviewed to determine if SUP was was appropriately administered, appropriately held, inappropriately administered, or inappropriately held. Any discrepancies were reviewed by the principal investigator. A t-test was performed to determine if statistical significance was achieved.RESULTS:There were 124 and 115 patients in the pre and post-intervention period respectively. There was an overall improvement of 5.64% (P = 0.21) after distribution of cards (Figure 1). Inappropriately given SUP use improved by 5.01% (P = 0.22). Inappropriately held SUP use improved by 0.61% (P = 0.78).CONCLUSION:Administration of cards improved appropriate prescribing. The cards provided a resource to aid in enhancing knowledge and on-the-go decision making. The availability of implementing these guidelines or similar such protocols using EMR may be more effective in reaching a wider audience of physicians and provide a consistent effect on prescribing habits.

Background. Gastric cancer (GC) is the fifth most common type of cancer and the fourth most common cause of cancer-related mortality. Although the risk of GC and peptic ulcer disease (PUD) is known to be increased by H. pylori infection, evidence regarding the direct relationship between PUD and GC across ethnicities is inconclusive. Therefore, we investigated the association between PUD and GC in the Stomach cancer Pooling (StoP) consortium. Methods. History of peptic ulcer disease was collected using a structured questionnaire in 11 studies in the StoP consortium, including 4106 GC cases and 6922 controls. The two-stage individual-participant data meta-analysis approach was adopted to generate a priori. Unconditional logistic regression and Firth’s penalized maximum likelihood estimator were used to calculate study-specific odds ratios (ORs) and 95% confidence intervals (CIs) for the association between gastric ulcer (GU)/duodenal ulcer (DU) and risk of GC. Results. History of GU and DU was thoroughly reported and used in association analysis, respectively, by 487 cases (12.5%) and 276 controls (4.1%), and 253 cases (7.8%) and 318 controls (6.0%). We found that GU was associated with an increased risk of GC (OR = 3.04, 95% CI: 2.07–4.49). No association between DU and GC risk was observed (OR = 1.03, 95% CI: 0.77–1.39). Conclusions. In the pooled analysis of 11 case–control studies in a large consortium (i.e., the Stomach cancer Pooling (StoP) consortium), we found a positive association between GU and risk of GC and no association between DU and GC risk.

Background and GoalsPeptic ulcer disease is the most frequent cause of upper gastrointestinal bleeding. We sought to establish the epidemiology and hemostasis success rate of the different treatment modalities in this setting.MethodsRetrospective cohort study using the National Inpatient Sample. Non-elective adult admissions with a principal diagnosis of ulcer bleeding were included. The primary outcome was endoscopic, radiologic and surgical hemostasis success rate. Secondary outcomes were patients’ demographics, in-hospital mortality and resource utilization. On subgroup analysis, gastric and duodenal ulcers were studied separately. Confounders were adjusted for using multivariate regression analysis.ResultsA total of 136,425 admissions (55% gastric and 45% duodenal ulcers) were included. The mean patient age was 67 years. The majority of patients were males, Caucasians, of lower income and high comorbidity burden. The endoscopic, radiological and surgical therapy and hemostasis success rates were 33.6, 1.4, 0.1, and 95.1%, 89.1 and 66.7%, respectively. The in-hospital mortality rate was 1.9% overall, but 2.4% after successful and 11.1% after failed endoscopic hemostasis, respectively. Duodenal ulcers were associated with lower adjusted odds of successful endoscopic hemostasis, but higher odds of early and multiple endoscopies, endoscopic therapy, overall and successful radiological therapy, in-hospital mortality, longer length of stay and higher total hospitalization charges and costs.ConclusionsThe ulcer bleeding endoscopic hemostasis success rate is 95.1%. Rescue therapy is associated with lower hemostasis success and more than a ten-fold increase in mortality rate. Duodenal ulcers are associated with worse treatment outcomes and higher resource utilization compared with gastric ulcers.