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

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. 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. 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. 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.