Proton Pump Inhibitors Versus Histamine 2 Receptor Antagonists for Stress Ulcer Prophylaxis in Critically Ill Patients: A Systematic Review and Meta-Analysis*

@article{Alhazzani2013ProtonPI,
  title={Proton Pump Inhibitors Versus Histamine 2 Receptor Antagonists for Stress Ulcer Prophylaxis in Critically Ill Patients: A Systematic Review and Meta-Analysis*},
  author={Waleed Alhazzani and Farhan M Alenezi and Roman Z. Jaeschke and Paul Moayyedi and Deborah J. Cook},
  journal={Critical Care Medicine},
  year={2013},
  volume={41},
  pages={693–705}
}
BACKGROUND Critically ill patients may develop bleeding caused by stress ulceration. [] Key MethodSEARCH METHODS We searched Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, ACPJC, CINHAL, online trials registries (clinicaltrials.gov, ISRCTN Register, WHO ICTRP), conference proceedings databases, and reference lists of relevant articles.
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220 Citations
Highly Influential Citations
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Background Citations
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Methods Citations
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Results Citations
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220 Citations

Efficacy and safety of proton pump inhibitors for stress ulcer prophylaxis in critically ill patients: a systematic review and meta-analysis of randomized trials

TLDR
PPIs were superior to H2RAs in preventing clinically important and overt GI bleeding, without significantly increasing the risk of pneumonia or mortality, and on Clostridium difficile infection.

Proton Pump Inhibitors Versus Histamine-2-Receptor Antagonists for Stress Ulcer Prophylaxis in Critically Ill Patients

TLDR
Among critically ill patients, PPI was associated with reduced clinically significant or overt GIB and no differences in pneumonia were seen with the use of either agent.

Stress ulcer prophylaxis with proton pump inhibitors or histamin-2 receptor antagonists in adult intensive care patients: a systematic review with meta-analysis and trial sequential analysis

TLDR
The occurrence of GI bleeding was reduced, but there is no firm evidence for a reduction in clinically important GI bleeding, and the effects of prophylactic proton pump inhibitors or histamine 2 receptor antagonists remain inconclusive.

Intravenous proton pump inhibitors for stress ulcer prophylaxis in critically ill patients: determining statistical equivalence according to evidence-based methods.

TLDR
It is indicated that intravenous pantoprazole and intravenous omeprazole are equivalent according to reasonable equivalence margins, which can be the basis to develop local acquisition tenders on these drugs.

Comparative Effectiveness of Proton Pump Inhibitors vs Histamine Type 2 Receptor Blockers for Preventing Clinically Important Gastrointestinal Bleeding During Intensive Care: A Population‐Based Study

Cost-Effectiveness of Histamine Receptor-2 Antagonist Versus Proton Pump Inhibitor for Stress Ulcer Prophylaxis in Critically Ill Patients*

TLDR
Histamine receptor-2 antagonist therapy appears to reduce costs with survival benefit comparable to proton pump inhibitor therapy for stress ulcer prophylaxis, and the uncertainty in the findings justifies a prospective trial.

Proton pump inhibitors versus histamine-2 receptor blockers for stress ulcer prophylaxis in patients with sepsis: a retrospective cohort study

TLDR
Among critically ill adult patients with sepsis at risk for GIB, SUP with PPIs was associated with higher in-hospital mortality and higher risk of GIB and pneumonia than H2Bs.

Histamine-2 receptor antagonists versus proton pump inhibitors for septic shock after lower gastrointestinal tract perforation: a retrospective cohort study using a national inpatient database

TLDR
There were no significant differences in gastrointestinal bleeding requiring endoscopic hemostasis within 28 days of admission, 28-day mortality, CDI, and hospital-acquired pneumonia between H2RA and PPI in patients with septic shock after lower gastrointestinal tract perforation in this retrospective cohort study using the Japanese Diagnosis Procedure Combination database.

Effect of Stress Ulcer Prophylaxis With Proton Pump Inhibitors vs Histamine-2 Receptor Blockers on In-Hospital Mortality Among ICU Patients Receiving Invasive Mechanical Ventilation: The PEPTIC Randomized Clinical Trial.

TLDR
Among ICU patients requiring mechanical ventilation, a strategy of stress ulcer prophylaxis with use of proton pump inhibitors vs histamine-2 receptor blockers resulted in hospital mortality rates of 18.3% vs 17.5%, respectively, however, study interpretation may be limited by crossover in the use of the assigned medication.

Stress ulcer prophylaxis with a proton pump inhibitor versus placebo in critically ill patients (SUP-ICU trial): study protocol for a randomised controlled trial

TLDR
The SUP-ICU trial will provide high-quality data on the benefits and harms of stress ulcer prophylaxis with a proton pump inhibitor in critically ill adult patients admitted in the ICU.
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References

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The efficacy and safety of proton pump inhibitors vs histamine-2 receptor antagonists for stress ulcer bleeding prophylaxis among critical care patients: A meta-analysis

TLDR
This meta-analysis did not find strong evidence that proton pump inhibitors were different from histamine-2 receptor antagonists in terms of stress-related upper gastrointestinal bleeding prophylaxis, pneumonia, and mortality among patients admitted to intensive care units.

Proton Pump Inhibitors vs. Histamine 2 Receptor Antagonists for Stress-Related Mucosal Bleeding Prophylaxis in Critically Ill Patients: A Meta-Analysis

TLDR
In critically ill patients at risk for the development of SRMB, PPI prophylaxis significantly decreased rates of clinically significant bleeding compared with H2RA, without affecting the developmentof nosocomial pneumonia or mortality rates.

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TLDR
PPI treatment in PU bleeding reduces rebleeding and surgical intervention rates in studies comparing treatment with placebo or H(2)RA, but there is no evidence of an effect on mortality.

Proton pump inhibitors for the prevention of stress-related mucosal disease in critically-ill patients: a meta-analysis.

TLDR
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.

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TLDR
The results of this meta-analysis suggest that, in those patients receiving enteral nutrition, stress ulcer prophylaxis may not be required and, indeed, such therapy may increase the risk of pneumonia and death.

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TLDR
Routine prophylaxis for stress-related bleeding even in high-risk patients seems not to be justified, and it is suggested that especially gastric pH increasing medication could increase the risk for nosocomial pneumonia.

Systematic Review of the Risk of Enteric Infection in Patients Taking Acid Suppression

TLDR
There is an association between acid suppression and an increased risk of enteric infection and further prospective studies on patients taking long-term acid suppression are needed to establish whether this association is causal.

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TLDR
There is strong evidence of reduced clinically important gastrointestinal bleeding with histamine2-receptor antagonists and sucralfate is as effective in reducing bleeding as gastric pH-altering drugs and is associated with lower rates of pneumonia and mortality.

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TLDR
This study showed a statistically significant difference between omeprazole and ranitidine in preventing overt GI bleeding among ICU patients; but it failed to indicate any difference in prophylaxis of clinically important GI bleeding between the two drugs.

Risk factors for gastrointestinal bleeding in critically ill patients

TLDR
Prophylaxis against stress ulcers can be safely withheld from critically ill patients unless they have coagulopathy or require mechanical ventilation, according to this prospective multicenter cohort study.