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Inventi Impact: Gastroenterology

Articles

  • Inventi:hgst/31232/20
    Stress Ulcer Prophylaxis with Proton Pump Inhibitors or Histamine 2 Receptor Antagonists in Critically Ill Adults - A Metaanalysis of Randomized Controlled Trials with Trial Sequential Analysis
    Research 2020 : April - June
    Xiaoyang Zhou, Hanyuan Fang, Jianfei Xu, Peifu Chen, Xujun Hu, Bixin Chen, Hua Wang, Caibao Hu, Zhaojun Xu

    Background: Proton pump inhibitors (PPI) and histamine 2 receptor antagonists (H2RA) have been widely used as\nstress ulcer prophylaxis (SUP) in critically ill patients, however, its efficacy and safety remain unclear. This study\naimed to assess the effect of SUP on clinical outcomes in critically ill adults.\nMethods: Literature search was conducted in PubMed, EMBASE, Web of Science, and the Cochrane database of\nclinical trials for randomized controlled trials (RCTs) that investigated SUP, with PPI or H2RA, versus placebo or no\nprophylaxis in critically ill patients from database inception through 1 June 2019. Study selection, data extraction\nand quality assessment were performed in duplicate. The primary outcomes were clinically important\ngastrointestinal (GI) bleeding and overt GI bleeding. Conventional meta-analysis with random-effects model and\ntrial sequential analysis (TSA) were performed.\nResults: Twenty-nine RCTs were identified, of which four RCTs were judged as low risk of bias. Overall, SUP could\nreduce the incident of clinically important GI bleeding [relative risk (RR) = 0.58; 95% confidence intervals (CI): 0.42â??\n0.81] and overt GI bleeding (RR = 0.48; 95% CI: 0.36â??0.63), these results were confirmed by the sub-analysis of trials\nwith low risk of bias, TSA indicated a firm evidence on its beneficial effects on the overt GI bleeding (TSA-adjusted\nCI: 0.31â??0.75), but lack of sufficient evidence on the clinically important GI bleeding (TSA-adjusted CI: 0.23â??1.51).\nAmong patients who received enteral nutrition (EN), SUP was associated with a decreased risk of clinically\nimportant GI bleeding (RR = 0.61; 95% CI: 0.44â??0.85; TSA-adjusted CI: 0.16â??2.38) and overt GI bleeding (RR = 0.64;\n95% CI: 0.42â??0.96; TSA-adjusted CI: 0.12â??3.35), but these benefits disappeared after adjustment with TSA. Among\npatients who did not receive EN, SUP had only benefits in reducing the risk of overt GI bleeding (RR = 0.37; 95% CI:\n0.25â??0.55; TSA-adjusted CI: 0.22â??0.63), but not the clinically important GI bleeding (RR = 0.27; 95% CI: 0.04â??2.09).\nConclusions: SUP has benefits on the overt GI bleeding in critically ill patients who did not receive EN, however, its\nbenefits on clinically important GI bleeding still needs more evidence to confirm.

    How to Cite this Article
    Attribution/ CC Compliant Citation: Zhou, Xiaoyang, et al.\n\"Stress ulcer prophylaxis with proton pump inhibitors or\nhistamine 2 receptor antagonists in critically ill adults-a\nmeta-analysis of randomized controlled trials with trial\nsequential analysis.\" BMC gastroenterology 19.1 (2019): 193.\nhttps://doi.org/10.1186/s12876-019-1105-y\nhttp://creativecommons.org/licenses/by/4.0/\n\nSome formatting elements, header, footer, logos, dates and\npagination were modified while adapting this article.
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