Proton pump inhibitors for the prevention of stress-related mucosal disease in critically-ill patients: a meta-analysis.
BACKGROUND
Despite the scanty data, proton pump inhibitors (PPI) are widely used for stress-related mucosal disease (SRMD) prophylaxis. There were few studies using PPI for SRMD prophylaxis but the results were conflicting, most probably due to inadequate sample size. The present meta-analysis aimed to determine the efficacy of PPI, as compared to histamine-2 receptor antagonists (H2RA) in the prevention of SRMD in critically-ill patients.


METHODS
Meta-analysis of the randomized controlled trials comparing PPI versus H2RA for SRMD prophylaxis was performed. Outcomes of interest were incidences of clinically important gastrointestinal bleeding and nosocomial pneumonia.


RESULTS
Three studies involving 569 patients were included in the meta-analysis. The overall incidence of clinically important bleeding was significantly lower in the PPI group (3.5%) as compared to H2RA (8%), odds ratio (OR) 0.42 (95% CI 0.20-0.91). The incidences of nosocomial pneumonia were not different (10.2% versus 10.1%, OR 1.02, 95% CI 0.59-1.75) between the two groups.


CONCLUSIONS
The use of PPI for SRMD prophylaxis was associated with a significantly lower rate of clinically important bleeding than H2RA with similar rates of nosocomial pneumonia.
Pongprasobchai
Supot
S
Division of Gastroenterology, Department of Internal Medicine, Siriraj Hospital, Bangkok, Thailand. tespb@mahidol.ac.th
Kridkratoke
Samruay
S
Nopmaneejumruslers
Cherdchai
C
D000897:Anti-Ulcer Agents / Q000009:adverse effects*; D016001:Confidence Intervals; D016638:Critical Illness; D003428:Cross Infection / Q000209:etiology; D005753:Gastric Mucosa; D006635:Histamine H2 Antagonists / Q000009:adverse effects*; D006801:Humans; D016017:Odds Ratio; D010437:Peptic Ulcer / Q000517:prevention & control*; D011014:Pneumonia / Q000209:etiology; D054328:Proton Pump Inhibitors / Q000009:adverse effects*; D016032:Randomized Controlled Trials as Topic; D013272:Stomach Diseases / Q000209:etiology; D013312:Stress, Physiological / Q000187:drug effects*; D016896:Treatment Outcome
D000897:Anti-Ulcer Agents; D006635:Histamine H2 Antagonists; D054328:Proton Pump Inhibitors