This article is part of Pulmonology Advisor‘s coverage of the CHEST 2019 meeting, taking place in New Orleans, LA. Our staff will report on medical research related to asthma, COPD, critical care medicine, and more conducted by experts in the field. Check back regularly for more news from CHEST 2019.


NEW ORLEANS — Proton pump inhibitors (PPIs) have demonstrated efficacy in reducing gastrointestinal (GI) bleeding without an increased risk for infection among patients in critical care. This research was recently presented at the 2019 CHEST Annual Meeting, held October 19 to 23, 2019, in New Orleans, Louisiana.

This meta-analysis included 4021 patients from 7 randomized controlled trials investigating PPI vs placebo in terms of efficacy and safety. Studies were identified using MEDLINE, EMBASE, PubMed, and the Cochrane Library, and researchers followed the Preferred Reporting Items for Systematic Review and Meta-Analysis statement. Participants were admitted to intensive care units and were ≥18 years old. Studies were not screened for language, status, or publication source, but were excluded if GI bleeding was the main indication for intensive care unit admission. 

“Using [a PPI] is an effective way for preventing peptic ulcer in critically ill patient[s] without increasing the risk of developing infection,” the researchers concluded.

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In terms of GI bleeding, PPIs were more effective than placebo at preventing clinically significant (odds ratio [OR], 0.59; 95% CI, 0.40-0.86) and clinically nonsignificant (OR, 0.47; 95% CI, 0.37-0.6) bleeds. The risk for infections was not significantly higher with PPIs vs placebo, with subanalysis demonstrating an OR of 1.03 (95% CI, 0.86-1.23) for pneumonia and 0.80 (95% CI, 0.45-1.44) for Clostridium difficile (overall OR, 1.02; 95% CI, 0.86-1.22 for PPI vs placebo). There was wide interstudy variation on baseline risk for GI bleeding. Pneumonia was reported in 5 studies, and C difficile was reported in 2. 

“Using [a PPI] is an effective way for preventing peptic ulcer in critically ill patient[s] without increasing the risk of developing infection,” the researchers concluded.

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Reference

Ahmed TS, Abdel-Aziz Y, Renno A, Awad M, Assaly R. Efficacy and safety of proton pump inhibitors use as stress ulcer prophylaxis in critical ill patients: meta-analysis of randomized controlled trials. Presented at: CHEST Annual Meeting 2019; October 19-23, 2019; New Orleans, LA. Abstract 1140.