Does Stress Ulcer Prophylaxis in Critically Ill Patients Work? A Meta-Analysis of Randomized Controlled Trials: 2017 Presidential Poster Award: 545

Introduction: Stress Ulcer prophylaxis (SUP) using Proton Pump Inhibitor (PPI) or H2 Receptor Blocker (H2RA) is widely used in critical care setting all over the world. Several randomized controlled trials testing efficacy of SUP have measured gastrointestinal bleeding as an outcome. Our objective was to obtain a collective evidence on SUP and its protective effect on gastrointestinal bleeding. Methods: The literature search was done from electronic databases including Pubmed, Cochrane, and Embase from inception until March 2017. 23 Randomized controlled trials that measured gastrointestinal bleeding as an outcome were isolated and relevant data was extracted. Statistical analysis was done using Rev Man 5.3. Results: A total of 23 randomized control trials measuring Gastrointestinal bleeding as an outcome were included. The total number of patients were 1802 in the intervention group and 1665 in the control group with 112 patients developing gastrointestinal bleeding in study group and 235 in control group. Overall, SUP significantly reduced the occurrence of gastrointestinal bleeding in critically ill patients [OR 0.36, 95%CI (0.28, 0.46), p < .00001]. Conclusion: Our large meta-analysis demonstrates a significant reduction in the occurrence of gastrointestinal bleeding in critically ill patients with the use of Stress Ulcer Prophylaxis. Hence, we strongly recommend the use of Stress Ulcer Prophylaxis in Critically ill patients with appropriate clinical indications. Though the study results are statistically significant, there are some limitations to this study - 1) the definition of gastrointestinal bleeding was different in different RCTs. 2) Head to head trials were not included. More high powered trials need to be done to identify the efficacy of newer PPIs which are widely used presently.Figure: Forest Plot comparing SUP and Control groups with GI bleed in critically-ill patients.Figure: Forest Plot comparing subgroup analysis of SUP with H2RA vs H2RA with PPI with GI bleed in critically-ill patients.