GI bleeding prophylaxis in the critically ill – PPIs and other acid suppression reduce GI bleeding but fail to impact overall mortality

Do critically ill patients benefit from GI bleeding prophylaxis (stress ulcer prophylaxis)? In the BMJ, a recent systematic review set out to assess the relative impact of proton pump inhibitors (PPIs), histamine-2 receptor antagonists (H2RAs), sucralfate, or no prophylaxis on outcomes. They included randomised controlled trials of pharmacological prophylaxis with PPIs, H2RAs, or sucralfate against each another or placebo or no prophylaxis in adult critically ill patients. 72 trials including 12 660 patients were included. The researchers found that for those at highest risk (>8%) or high risk (4-8%) of bleeding, both PPIs and H2RAs probably reduce clinically important GI bleeding compared with placebo or no prophylaxis (odds ratio for PPIs 0.61 (95% confidence interval 0.42 to 0.89), 3.3% fewer for highest risk and 2.3% fewer for high risk patients; odds ratio for H2RAs 0.46 (0.27 to 0.79), 4.6% fewer for highest risk and 3.1% fewer for high risk patients). Neither approach seems to definitively affect mortality (PPIs 1.06 (0.90 to 1.28); H2RAs 0.96 (0.79 to 1.19).  Clostridium difficile infection, length of intensive care stay, length of hospital stay, or duration of mechanical ventilation were also not convincingly impacted. Read details of the study in the BMJ here.