Stress ulcer prophylaxis: gastrointestinal bleeding and nosocomial pneumonia. Best evidence synthesis.
OBJECTIVE
To examine the effect of stress ulcer prophylaxis on gastrointestinal bleeding, pneumonia, and mortality.


METHODS
Computerized search of published and unpublished research, bibliographies, pharmaceutical and personal files and abstract reports. Independent review of 257 articles identified 71 relevant randomized trials for inclusion. We made independent, duplicate assessment of the methodologic quality, population, intervention and outcomes of each trial.


RESULTS
This overview demonstrates that prophylaxis with histamine-2-receptor antagonists decreases the incidence of overt gastrointestinal bleeding (odds ratio 0.29 [95% CI 0.17-0.45]) and clinically important bleeding (odds ratio 0.35 [95% CI 0.15-0.76]). There is a trend to decreased overt bleeding when antacids are compared with no therapy (odds ratio 0.35 [95% CI 0.08-1.33]). Although sucralfate, antacids, and histamine-2-receptor antagonists are equivalent in reducing clinically important bleeding, sucralfate decreases the incidence of nosocomial pneumonia compared with antacids and/or histamine-2-receptor antagonists (odds ratio 0.50 [95% CI 0.21-0.79]). Sucralfate is associated with lower mortality relative to antacids (odds ratio 0.70 [95% CI 0.52-0.94]), and relative to histamine-2-receptor antagonists (odds ratio 0.71 [95% CI 0.49-1.04]).


CONCLUSIONS
All stress ulcer prophylactic agents appear to be effective in decreasing bleeding. Prophylaxis with sucralfate is associated with a lower rate of nosocomial pneumonia and mortality, providing strong evidence for use of this agent in clinical practice.
Cook
D J
DJ
Dept. of Medicine, St Joseph's Hospital, McMaster University, Hamilton, Canada.
D000897:Anti-Ulcer Agents / Q000627:therapeutic use; D002986:Clinical Trials as Topic; D016001:Confidence Intervals; D016638:Critical Illness; D003428:Cross Infection / Q000453:epidemiology / Q000401:mortality / Q000517:prevention & control*; D006635:Histamine H2 Antagonists / Q000627:therapeutic use; D006801:Humans; D015994:Incidence; D016017:Odds Ratio; D010437:Peptic Ulcer / Q000401:mortality / Q000517:prevention & control*; D010438:Peptic Ulcer Hemorrhage / Q000453:epidemiology / Q000401:mortality / Q000517:prevention & control*; D011014:Pneumonia / Q000453:epidemiology / Q000401:mortality / Q000517:prevention & control*; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D013312:Stress, Physiological / Q000150:complications
D000897:Anti-Ulcer Agents; D006635:Histamine H2 Antagonists