Stress Ulcer Prophylaxis in the ICU: PPIs or H₂-Blockers?

Gastrointestinal stress ulceration occurs commonly in critically ill patients. Clinically important bleeding occurs in 1% to 4% of such cases and is associated with mortality as high as 50%. To examine whether stress ulcer prophylaxis with proton-pump inhibitors (PPIs) leads to better patient outcomes than histamine-2 receptor antagonists (H₂RAs), investigators performed a meta-analysis of 14 randomized controlled trials in which the two agents were compared in 1720 critically ill patients.

Compared with H₂RAs, PPIs significantly lessened risk for clinically important bleeding (by 64%). No differences were found in intensive care unit (ICU) mortality, ICU length of stay, or hospital-acquired pneumonia. No trial reported the incidence of Clos…