Proton-Pump Inhibitors to Prevent Gastrointestinal Bleeding — An Updated Meta-Analysis

• DOI: 10.1056/evidoa2400134
• Publication Date: 2024-06-14T14:40:26Z
• Authors: Ying Wang; Sameer Parpia; Long Ge; Diane Heels-Ansdell; Honghao Lai; Meisam Abdar Esfa...; Bei Pan; Waleed Alhazzani; Stefan Schandelmaier; Francois Lauzier; Yaseen Arabi; Jeffrey Barletta; Adam Deane; Simon Finfer; David Williamson; Salmaan Kanji; Morten H. Møller; Anders Perner; Mette Krag; Paul J. Young; Joanna C. Dionne; Naomi Hammond; Zhikang Ye; Quazi Ibrahim; Deborah Cook
• Keywords: Stress ulcer; Subgroup analysis

BackgroundThe goal of this systematic review was to examine the efficacy and safety proton-pump inhibitors for stress ulcer prophylaxis in critically ill patients.MethodsWe included randomized trials comparing versus placebo or no adults, performed meta-analyses, assessed certainty evidence using Grading Recommendations, Assessment, Development, Evaluations approach. To explore effect on mortality based disease severity, a subgroup analysis conducted combining within-trial data from two largest credibility Instrument Assessing Credibility Effect Modification Analyses.ResultsTwelve that enrolled 9533 patients were included. Proton-pump associated with reduced incidence clinically important upper gastrointestinal bleeding (relative risk [RR], 0.51 [95% confidence interval (CI), 0.34 0.76]; high evidence). may have little (RR, 0.99 CI, 0.93 1.05]; low certainty). Within-trial intermediate suggested differ severity. Subgroup results raise possibility decrease 90-day less severely 0.89; 95% 0.80 0.98) increase more 1.08; 0.96 1.20]. pneumonia Clostridioides difficile infection (low certainty).ConclusionsHigh supports association decreased bleeding. mortality, although an remain possible. (PROSPERO number CRD42023461695.)