Prophylaxis of stress ulcer bleeding. A meta-analysis

Abstract

Recent studies have reported upper gastrointestinal tract bleeding in 5-25% of intensive care unit (ICU) patients with severe stress despite the use of antacids and/or H2-antagonists. To evaluate the efficacy of this regimen, a meta-analysis of all prospective studies on the prevention of stress bleeding, available from the international literature, was conducted. Only macroscopically visible bleeds were considered. Because alkalinization of the gastric juice has been incriminated in facilitating gastric and pulmonary colonization, agents with little or no influence on the gastric pH have been increasingly investigated in stress bleeding prophylaxis. The meta-analysis was therefore extended to determine the efficacy of two newer substances, pirenzepine and sucralfate, in preventing macroscopically visible stress bleeding, as well as their influence on pulmonary infections and mortality. Antacids and H2-antagonists proved to be significantly superior to untreated controls, with the tendency in favor of antacids administered in short intervals as compared to H2-antagonists. Pirenzepine and sucralfate were significantly superior to H2-antagonists, and sucralfate was as effective as an adequate antacid regimen. Patient groups treated with antacids or H2-antagonists showed a significantly higher risk for the development of nosocomial pneumonia. The most significant differences was found in long-term ventilated patients compared with patients treated with sucralfate. In the same patient group, antacids and H2-antagonists also showed a significantly higher mortality rate than sucralfate.