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J Med Assoc Thai. 2009 May;92(5):632-7.

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

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  • 1Division of Gastroenterology, Department of Internal Medicine, Siriraj Hospital, Bangkok, Thailand. tespb@mahidol.ac.th

Abstract

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.

PMID:
19459523
[PubMed - indexed for MEDLINE]
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