Stress ulcer prophylaxis in the critically ill patients

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Ahmed Saeed Mohamed Ibrahim ◽  
Sameh Salem Hefni Taha ◽  
Samuel Habachi Daniel ◽  
Emil Noshy Aziz Salh

Abstract Background Sfress Ulceration was an important cause of morbidity and mortality in critically ill patients. Early active treatment reduces the risk of clinically significant bleeding, ulcer prophylaxis therefore became a standard of care in all critically ill patients. Objective The overall aims of the Stress ulcer prophylaxis in the critically ill patients is to determine the benefits and risks of stress ulcer prophylaxis stress ulcer prophylaxis (SUP) in intensive care unit Materials and Methods We performed this systematic review and meta-analysis according to the recommendations of the Meta-analysis of Observational Studies in Epidemiology (MOOSE) statement and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. In the our systematic review and meta-analysis, we searched Medline via PubMed, CENTRAL, Web of Science, SCOPUS, and Google Scholar from March 1977 till August 2019. The search retrieved 2289 unique records. We then obtained 237 final results for full-text screening. At last, 28 recorded studies were involved in our in the present study. Results 23 included studies reported the rates of clinically important GI bleeding. The overall effect estimates favored SUP over control for decreasing the hazards of clinically significant GI hemorrhage (P value <0.001, OR— 0.55, CI of 95%[0.35 0.86]). The overall effect estimates did not favor SUP over control for reducing the rate of death (P value =0.24, OR 1.21, 95% CI [0.87 — 1.69]). 23 studies reported the rates of pneumonia. The overall effect estimates showed that the SUP was not related to elevated hazards of nosocomial pneumonia over control (P value —0.15, OR —1.5, CI of 95% [0.83 3.02]). The analysis showed that only Cimetidine 900 mg was effective in reducing the incidence of clinically important GI bleeding (OR 0.45 [0.24, 0.82], p *0.009). In contrary, none of the included PPIs (pantoprazole, lansoprazole, omeprazole), ranitidine, or sucralfate were effective in reducing the incidence of clinically important GI bleeding. Conclusion SUP is associated with lower risk of GI bleeding in critically ill patients; however, the current published literature shows significant inconsistency. Our analysis showed that, no significant difference between H2RA and PPI in term of incidence of clinically important GI bleeding, H2RAs (mainly cimetidine) more effective than other classes of SUP which significantly reduced the risk of overt GI hemorrhage, and none of the drug classes was effective in reducing the mortality rates.

2021 ◽  
pp. 106002802110590
Author(s):  
Na He ◽  
Yingying Yan ◽  
Shan Su ◽  
Qinggang Ge ◽  
Suodi Zhai

Background: Histamine-2-receptor antagonists (H2RAs) have been largely replaced by proton pump inhibitors (PPIs) for stress ulcer prophylaxis (SUP) despite the inconclusive evidence concerning comparative effectiveness. Objective: To compare the effectiveness of PPIs and H2RAs on SUP in real-world setting. Methods: PubMed, Embase, and the Cochrane Library were searched from inception to September 19, 2021. We included cohort studies comparing PPIs with H2RAs in critically ill adult patients and explicitly reporting the outcome of gastrointestinal (GI) bleeding or mortality. Newcastle-Ottawa Scale was used to assess potential risk of bias. We conducted a random-effects meta-analysis and only the studies with adjusted effect estimates were pooled. The Grading of Recommendations Assessment, Development, and Evaluation system was used to assess the overall quality of the evidence. Results: Thirteen cohort studies (N = 145 149) were eligible and 11 of them available for full texts were of low to moderate risk of bias. Meta-analysis of adjusted effect estimates indicated that PPIs were associated with a significantly higher risk of GI bleeding, compared with H2RAs (8 studies, odds ratio [OR] = 1.98, 95% confidence interval [CI] = 1.30-3.01, low certainty). Post hoc pooling analysis also suggested that PPIs were associated with a slightly higher risk of mortality in comparison with H2RAs (7 studies, OR = 1.27, 95% CI = 1.13-1.42, low certainty). Conclusion and Relevance: The systematic review of cohort studies showed that PPIs were associated with higher risks of GI bleeding and mortality, although the certainty of evidence was low. Overall, we suggest not excluding H2RAs for SUP, while further studies are essential for elucidating the risk stratification, optimal regimen, and specific duration.


2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Xiaoyang Zhou ◽  
Hanyuan Fang ◽  
Jianfei Xu ◽  
Peifu Chen ◽  
Xujun Hu ◽  
...  

Abstract Background Proton pump inhibitors (PPI) and histamine 2 receptor antagonists (H2RA) have been widely used as stress ulcer prophylaxis (SUP) in critically ill patients, however, its efficacy and safety remain unclear. This study aimed to assess the effect of SUP on clinical outcomes in critically ill adults. Methods Literature search was conducted in PubMed, EMBASE, Web of Science, and the Cochrane database of clinical trials for randomized controlled trials (RCTs) that investigated SUP, with PPI or H2RA, versus placebo or no prophylaxis in critically ill patients from database inception through 1 June 2019. Study selection, data extraction and quality assessment were performed in duplicate. The primary outcomes were clinically important gastrointestinal (GI) bleeding and overt GI bleeding. Conventional meta-analysis with random-effects model and trial sequential analysis (TSA) were performed. Results Twenty-nine RCTs were identified, of which four RCTs were judged as low risk of bias. Overall, SUP could reduce the incident of clinically important GI bleeding [relative risk (RR) = 0.58; 95% confidence intervals (CI): 0.42–0.81] and overt GI bleeding (RR = 0.48; 95% CI: 0.36–0.63), these results were confirmed by the sub-analysis of trials with low risk of bias, TSA indicated a firm evidence on its beneficial effects on the overt GI bleeding (TSA-adjusted CI: 0.31–0.75), but lack of sufficient evidence on the clinically important GI bleeding (TSA-adjusted CI: 0.23–1.51). Among patients who received enteral nutrition (EN), SUP was associated with a decreased risk of clinically important GI bleeding (RR = 0.61; 95% CI: 0.44–0.85; TSA-adjusted CI: 0.16–2.38) and overt GI bleeding (RR = 0.64; 95% CI: 0.42–0.96; TSA-adjusted CI: 0.12–3.35), but these benefits disappeared after adjustment with TSA. Among patients who did not receive EN, SUP had only benefits in reducing the risk of overt GI bleeding (RR = 0.37; 95% CI: 0.25–0.55; TSA-adjusted CI: 0.22–0.63), but not the clinically important GI bleeding (RR = 0.27; 95% CI: 0.04–2.09). Conclusions SUP has benefits on the overt GI bleeding in critically ill patients who did not receive EN, however, its benefits on clinically important GI bleeding still needs more evidence to confirm.


CHEST Journal ◽  
2017 ◽  
Vol 152 (4) ◽  
pp. A345
Author(s):  
Diwas Shahi ◽  
Ajai Rajabalan ◽  
Jonathan Barrera-Calix ◽  
Sunil Paudel ◽  
Tamer Said Ahmed ◽  
...  

2003 ◽  
Vol 29 (8) ◽  
pp. 1306-1313 ◽  
Author(s):  
Christophe Faisy ◽  
Emmanuel Guerot ◽  
Jean-Luc Diehl ◽  
Eléonore Iftimovici ◽  
Jean-Yves Fagon

2017 ◽  
Vol 44 (2) ◽  
pp. 277-278 ◽  
Author(s):  
Waleed Alhazzani ◽  
Fayez Alshamsi ◽  
Emilie Belley-Cote ◽  
Diane Heels-Ansdell ◽  
Romina Brignardello-Petersen ◽  
...  

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