Stress ulcer prophylaxis plus enteral nutrition versus enteral nutrition alone in critically ill patients at risk for gastrointestinal bleeding: a propensity-matched analysis

AbstractProton pump inhibitors (PPIs), followed by histamine 2 receptor antagonists (H2RAs), are the most commonly used drugs to prevent gastrointestinal bleeding in critically ill patients through stress ulcer prophylaxis. The relative efficacy and drug-related adverse events of PPIs and H2RAs remain unclear. In this retrospective, observational, comparative cohort study, PPIs and H2RAs for stress ulcer prophylaxis in critically ill patients were compared using a common data model. After propensity matching, 935 patients from each treatment group (PPI or H2RA) were selected. The PPI group had a significantly higher 90-day mortality than the H2RA group (relative risk: 1.28; P = 0.01). However, no significant inter-group differences in the risk of clinically important gastrointestinal bleeding were observed. Moreover, there were no significant differences between the groups concerning the risk of pneumonia or Clostridioides difficile infection, which are known potential adverse events related to these drugs. Subgroup analysis of patients with high disease severity were consistent with those of the total propensity score-matched population. These findings do not support the current recommendations, which prefer PPIs for gastrointestinal bleeding prophylaxis in the intensive care unit.

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Upper Gastrointestinal Bleeding in Critically Ill Patient: Literature Review

The Indonesian Journal of Gastroenterology Hepatology and Digestive Endoscopy ◽

10.24871/2232021226-233 ◽

2022 ◽

Vol 22 (3) ◽

pp. 226-233

Author(s):

William Faisal ◽

Luciana Rotty

Keyword(s):

At Risk ◽

Gastrointestinal Tract ◽

Gastrointestinal Bleeding ◽

Critically Ill ◽

Critically Ill Patients ◽

Stress Ulcer ◽

Upper Gastrointestinal Tract ◽

Stress Ulcers ◽

Ulcer Prophylaxis ◽

Upper Gastrointestinal

Critically ill patients are at risk for stress ulcers in the upper digestive tract. Various risk factors have been associated with this condition. Patients who are critically ill are at risk of bleeding due to stress related mucosal disease (SRMD). Upper gastrointestinal tract problems usually occur as a result of severe physiological stress. Patients may develop gastric erosion and develop stress ulcers with severe gastrointestinal bleeding which can be fatal. Routine pharmacological use of stress ulcer prophylaxis (SUP) does not reduce overall mortality in intensive care patients. This increases the risk of infectious complications, particularly nosocomial pneumonia and Clostridium difficile-associated diarrhea. Early enteral nutrition has been shown to be effective in preventing stress ulceration of the upper gastrointestinal tract in critically ill patients. Routine use of stress ulcer prophylaxis in all critically ill patients may be dangerous and does not appear to be cost-effective. SUP administration must follow an algorithm that clearly balances risks and benefits.

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