2026 Eastern States Conference

Title: Systemic corticosteroids with or without stress ulcer prophylaxis: a retrospective comparative analysis of gastrointestinal bleeding risk and adverse outcomes

Authors: Sara Girgis, PharmD; Shivankar Vajinepalli, PharmD; Megan Trombi, PharmD; Yong-Bum Song, PharmD

Objective: The audience will be able to compare the risk of stress-related gastrointestinal bleeding (GIB) in hospitalized patients receiving systemic corticosteroids (SCS) with and without stress ulcer prophylaxis (SUP).

Self-Assessment Question: True/false: The 2024 Society of Critical Care Medicine (SCCM) Guideline for the Prevention of Stress-Related GIB in Critically Ill Adults considers SCS a risk factor for stress-related GIB that necessitates SUP. 

Background: Evidence correlating SCS and GIB is limited, and current guidelines do not recommend SUP for patients receiving SCS. This study aimed to evaluate whether coadministration of SUP is associated with a lower incidence of GIB in patients receiving SCS.

Methods: This single-center, retrospective chart review included patients aged 18 years or older who received SCS for at least 24 hours, with or without coadministration of SUP such as pantoprazole or famotidine. Patients with active GIB upon admission or with risk factors for GIB who required SUP, were excluded. The primary outcome compared the incidence of clinically important GIB between the cohorts. The secondary outcomes assessed the occurrence of adverse effects associated with SUP, including newly confirmed pneumonia, Clostridium difficile, and change in platelet count. 

Results: The analysis included 412 patients, of whom 176 received SCS along with SUP and 236 received SCS alone. Among those patients, clinically significant GIB was observed in one patient (0.4%) from the SCS-alone group (p > 0.99). Newly confirmed pneumonia developed in 14 patients overall, consisting of 4 patients (3.4%) in the SCS + SUP group and 10 patients (4.2%) in the SCS-alone group (p = 0.28). There were no reported cases of Clostridium difficile in either cohort. The median change in platelet count for the SCS + SUP group was -15, whereas the SCS-alone group was -13 (p = 0.31).


Conclusions: The use of SUP was not associated with a lower incidence of clinically significant GIB among patients receiving SCS. The incidence of newly confirmed pneumonia, Clostridium difficile infection, and change in platelet count were not significantly different between the cohorts. Future research involving larger sample sizes is essential to further assess whether SUP is associated with a lower incidence of clinically significant GIB in this patient population.