Should Patients with Low Body Mass Index and Hypoalbuminemia on Chemoradiation Be Prescribed Prophylactic Proton Pump Inhibitors?

Introduction: The common causes of peptic ulcer disease are H. pylori infection and NSAIDs. Other factors such as physiological stress, smoking, steroid use, and previous history of PUD also increase the risk for developing gastric ulcers. Medical therapy has become more effective and accessible, leading to a decrease in the risk of complications by 2 -3% per year and a decline of 30-40% in the USA from 1993 to 2006. However, chemoradiation, which is increasingly used in the management of cancer patients, can cause mucosal injuries and other complications. Although there is no established support for prophylactic PPIs for cancer patients undergoing chemoradiation, a subset of patients with risk factors for systemic chemotoxicity and vulnerability to stress ulcers should be carefully evaluated and prescribed short-term PPIs to reduce complications and avoid unnecessary hospitalization. Method: No IRB approval was obtained: Two case reports of cancer patients with gastrointestinal tumors who presented to the Emergency Room with abdominal pain shortly after receiving chemoradiation are described. Both patients were not prescribed PPIs prior to their chemoradiation therapy and were found to have gastric perforation, requiring exploratory laparotomy with Graham patch and prolonged hospitalization. Results: According to studies, chemoradiation increases the risk of mucosal injuries and consequently the risk of developing stress gastric ulcers. Patients with borderline low BMI (<18.5) and hypoalbuminemia (<3.5dg/L) who undergo such treatment have a higher risk of developing stress mucosal injuries compared to average patients. Conclusion: These case reports highlight that low BMI and hypoalbuminemia increase the risk of developing stress gastric ulcers in patients undergoing chemoradiation due to mucosal toxicity. Therefore, this specific patient population should be carefully evaluated and prescribed short-term PPIs prophylactically to prevent gastric ulcers, thereby reducing the risk of emergent surgical intervention and unnecessary hospitalization.