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Original ArticleOpen Access
Proton Pump Inhibitors for the Prevention of Stress-Related Mucosal Disease in Critically-Ill Patients: A Meta-Analysis
Pongprasobchai S 
,
Kridkratoke S ,
Nopmaneejumruslers C
,
Kridkratoke S ,
Nopmaneejumruslers C 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.
Material and Method: 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.
Conclusion: 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.
Keywords: Stress-related mucosal disease, Stress ulcer, Prophylaxis, Proton pump inhibitor, Omeprazole,
Histamine-2 receptor antagonist
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.
Material and Method: 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.
Conclusion: 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.
Keywords: Stress-related mucosal disease, Stress ulcer, Prophylaxis, Proton pump inhibitor, Omeprazole,
Histamine-2 receptor antagonist
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