The efficacy and safety of proton pump inhibitors vs histamine-2 receptor antagonists for stress ulcer bleeding prophylaxis among critical care Patients: A meta-analysis
Journal
Critical Care Medicine
Journal Volume
38
Journal Issue
4
Pages
1197-1205
Date Issued
2010
Author(s)
Abstract
Objective: To examine the efficacy and safety of proton pump inhibitors in comparison with histamine-2 receptor antagonists for stress-related upper gastrointestinal bleeding prophylaxis among critical care patients. DATA SOURCES: PubMed, EMBASE, Cochrane Library, and ClinicalTrials.gov. STUDY SELECTION: Randomized, controlled trials that directly compare proton pump inhibitors with histamine-2 receptor antagonists in prevention of stress-related upper gastrointestinal bleeding in intensive care unit patients published before May 30, 2008. DATA EXTRACTION: Two reviewers independently applied selection criteria, performed quality assessment, and extracted data. The primary outcome was the incidence of stress-related upper gastrointestinal bleeding, and the secondary outcome measures were the incidence of pneumonia and intensive care unit mortality. DATA SYNTHESIS: The random effect model was used to estimate the pooled risk difference between two treatment arms irrespective of drug, dosage, and route of administration. Results: We identified seven randomized, controlled trials with a total of 936 patients for planned comparison. The overall pooled risk difference (95% confidence interval; p value; I statistics) of stress-related upper gastrointestinal bleeding comparing proton pump inhibitors vs. histamine-2 receptor antagonists was-0.04 (95% confidence interval,-0.09-0.01; p =.08; I = 66%). In the sensitivity analysis, removing the Levy study significantly reduced the heterogeneity (from I = 66% to I = 26%) and shifted the overall risk difference closer to the null (pooled risk difference,-0.02; 95% confidence interval,-0.05-0.01; p =.19). There was no difference between proton pump inhibitors and histamine-2 receptor antagonists therapy in the risk of pneumonia and intensive care unit mortality, with pooled risk differences of 0.00 (95% confidence interval,-0.04-0.05; p =.86; I = 0%) and 0.02 (95% confidence interval,-0.04-0.08; p =.50; I = 0%), respectively. Conclusions: This meta-analysis did not find strong evidence that proton pump inhibitors were different from histamine-2 receptor antagonists in terms of stress-related upper gastrointestinal bleeding prophylaxis, pneumonia, and mortality among patients admitted to intensive care units. Because of limited trial data, future well-designed and powerful randomized, clinical trials are warranted. ? 2010 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins.
SDGs
Other Subjects
cimetidine; esomeprazole; famotidine; histamine H2 receptor antagonist; lansoprazole; omeprazole; pantoprazole; proton pump inhibitor; rabeprazole; ranitidine; sucralfate; article; attributable risk; clinical trial; confidence interval; drug efficacy; drug safety; human; incidence; intensive care; intensive care unit; meta analysis; mortality; outcome assessment; peptic ulcer bleeding; pneumonia; priority journal; quality control; risk assessment; risk factor; statistical significance; systematic review; treatment outcome; treatment response
Publisher
Lippincott Williams and Wilkins
Type
review