Proton Pump Inhibitors for the Prevention of Stress-Related Mucosal Disease in Critically-Ill Patients: A Meta-Analysis
Supot Pongprasobchai MD*, Samruay Kridkratoke MD*, Cherdchai Nopmaneejumruslers MD**
Affiliation : * Division of Gastroenterology, Department of Internal Medicine, Siriraj Hospital, Bangkok, Thailand ** Division of Ambulatory Medicine, Department of Internal Medicine, Siriraj Hospital, Bangkok, Thailand
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
