Proton Pump Inhibitors vs Histamine-2 Receptor Blockers for Stress Ulcer Prophylaxis in ICU Patients

Among critically ill patients in the intensive care unit (ICU), complications are frequent, including stress ulcers in the upper gastrointestinal tract. To help prevent the development of ulcers, antagonism of gastric acid (with antacids historically) or inhibition of the production of acid (with histamine-2 receptor blockers more recently) were implemented as part of routine critical care. The introduction of proton pump inhibitors, with data demonstrating improved ulcer prevention and recovery compared with histamine-2 receptor blockers in non –critically ill patients, led many physicians who provide care for critically ill patients to incorporate proton pump inhibitors for routine stress ulcer prophylaxis. However, the lack of randomized clinical trials (RCTs) that directly compared histamine-2 receptor blockers with proton pump inhibi tors for stress ulcer prophylaxis in critically ill patients, combined with decreasing incidence of significant gastrointestinal bleeding in these patients and emerging evidence of an association between proton pump inhibitor use and adverse events, including Clostridioides difficile (Clostridium di fficile) infection, cognitive decline, and nosocomial pneumonia, made the optimal choice of routine stress ulcer prophylaxis less clear.

Source: JAMA - Journal of the American Medical Association - January 17, 2020 Category: General Medicine Source Type: research