Proton-Pump Inhibitors to Prevent Gastrointestinal Bleeding — An Updated Meta-Analysis
Ying Wang, Sameer Parpia, Long Ge, Diane Heels‐Ansdell, Honghao Lai, Meisam Abdar Esfahani, Bei Pan, Waleed Alhazzani, Stefan Schandelmaier, François Lauzier, Yaseen M. Arabi, Jeffrey F. Barletta, Adam M. Deane, Simon Finfer, David Williamson, Salmaan Kanji, Morten Hylander Møller, Anders Perner, Mette Krag, Paul J. Young, Joanna C. Dionne, Naomi Hammond, Zhikang Ye, Quazi Ibrahim, Deborah Cook
Abstract
BACKGROUND: The goal of this systematic review was to examine the efficacy and safety of proton-pump inhibitors for stress ulcer prophylaxis in critically ill patients. METHODS: We included randomized trials comparing proton-pump inhibitors versus placebo or no prophylaxis in critically ill adults, performed meta-analyses, and assessed certainty of evidence using the Grading of Recommendations, Assessment, Development, and Evaluations approach. To explore the effect of proton-pump inhibitors on mortality based on disease severity, a subgroup analysis was conducted combining within-trial subgroup data from the two largest trials and assessed credibility using the Instrument for Assessing the Credibility of Effect Modification Analyses. RESULTS: infection (low certainty). CONCLUSIONS: High certainty evidence supports the association of proton-pump inhibitors with decreased upper gastrointestinal bleeding. Proton-pump inhibitors may have little or no effect on mortality, although a decrease in mortality in less severely ill patients and an increase in mortality in more severely ill patients remain possible. (PROSPERO number CRD42023461695.).