SynthesisCritical care (London, England)2016
Efficacy and safety of proton pump inhibitors for stress ulcer prophylaxis in critically ill patients: a systematic review and meta-analysis of randomized trials.
Synthesis in Critical care (London, England), 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 66 papers, 8 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
66 citing papers in PubMed, 8 syntheses or guidelines pooled it, 147 citations in OpenAlex.
- Summary of the best evidence for stress ulcer prophylaxis in critically ill patients.Frontiers in medicine · 2026Pooled it
- [S3 Guideline Sepsis-prevention, diagnosis, therapy, and aftercare : Long version].Medizinische Klinik, Intensivmedizin und Notfallmedizin · 2020Guideline
- Efficacy and safety of gastrointestinal bleeding prophylaxis in critically ill patients: systematic review and network meta-analysis.BMJ (Clinical research ed.) · 2020Pooled it
- Stress ulcer prophylaxis with proton pump inhibitors or histamin-2 receptor antagonists in adult intensive care patients: a systematic review with meta-analysis and trial sequential analysis.Intensive care medicine · 2019Pooled it
- Sociedade Portuguesa de Cuidados Intensivos guidelines for stress ulcer prophylaxis in the intensive care unit.Revista Brasileira de terapia intensiva · 2019Guideline
- Interventions for preventing upper gastrointestinal bleeding in people admitted to intensive care units.The Cochrane database of systematic reviews · 2018Pooled it
- Effects of gastroprotectant drugs for the prevention and treatment of peptic ulcer disease and its complications: a meta-analysis of randomised trials.The lancet. Gastroenterology & hepatology · 2018Pooled it
- Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016.Intensive care medicine · 2017Guideline
- Predictors and therapeutic yield of oesophagogastroduodenoscopy in critically and morbidly ill patients presenting with coffee-ground vomitus.Surgical endoscopy · 2026Article
- Preoperative proton pump inhibitor therapy and its influence on postoperative complications following major liver resection.Langenbeck's archives of surgery · 2026Article
- Association of Direct Oral Anticoagulant-Proton Pump Inhibitor Co-Therapy with Adverse Outcomes: A Population-Based Cohort Study.The Annals of pharmacotherapy · 2026Article
- Prophylactic Proton Pump Inhibitors in Critically Ill Patients Undergoing Invasive Ventilation: A Systematic Review and Meta-Analysis of Randomized Trials.Critical care research and practice · 2026Article
- Efficacy and safety of ilaprazole for stress ulcer - associated upper gastrointestinal bleeding prophylaxis in critically ill patients: a randomized, double-blind, non-inferiority phase 3 trial.Annals of intensive care · 2026Article
- Systematic analysis of proton pump inhibitors-related adverse reactions using the FDA adverse event reporting system database.PloS one · 2026Article
- Preoperative proton pump inhibitor therapy and anastomotic leak after esophagectomy-a new perspective.Langenbeck's archives of surgery · 2025Article
- Effectiveness of a multi-modal intervention protocol for preventing stress ulcers in critically ill older patients after gastrointestinal surgery.World journal of gastrointestinal surgery · 2025Article
- Risk Factors for Upper Gastrointestinal Bleeding in Patients Undergoing Percutaneous Coronary Intervention on Dual Antiplatelet Therapy with Assessment of Anti-Ulcer Medication Effects.Acta Cardiologica Sinica · 2025Article
- Mind the gut: Navigating the complex landscape of gastroprotection in neurosurgical patients.World journal of gastroenterology · 2025Article
- Optimizing stress ulcer prophylaxis practices and reducing associated costs in intensive care units: a non-randomized controlled study.Journal of pharmacy & pharmaceutical sciences : a publication of the Canadian Society for Pharmaceutical Sciences, Societe canadienne des sciences pharmaceutiques · 2025Article
- Prophylactic proton pump inhibitor use and all-cause mortality in adult sepsis patients: a retrospective analysis based on the MIMIC-IV database.Frontiers in pharmacology · 2025Article
6 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
11 authors at 4 institutions in 3 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThe relative efficacy and safety of proton pump inhibitors (PPIs) compared to histamine-2-receptor antagonists (H2RAs) should guide their use in reducing bleeding risk in the critically ill.
methodsWe searched the Cochrane library, MEDLINE, EMBASE, ACPJC, clinical trials registries, and conference proceedings through November 2015 without language or publication date restrictions. Only randomized controlled trials (RCTs) of PPIs vs H2RAs for stress ulcer prophylaxis in critically ill adults for clinically important bleeding, overt gastrointestinal (GI) bleeding, nosocomial pneumonia, mortality, ICU length of stay and Clostridium difficile infection were included. We used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to assess our confidence in the evidence for each outcome.
resultsIn 19 trials enrolling 2117 patients, PPIs were more effective than H2RAs in reducing the risk of clinically important GI bleeding (RR 0.39; 95 % CI 0.21, 0.71; P = 0.002; I (2) = 0 %, moderate confidence) and overt GI bleeding (RR 0.48; 95 % CI 0.34, 0.66; P < 0.0001; I (2) = 3 %, moderate confidence). PPI use did not significantly affect risk of pneumonia (RR 1.12; 95 % CI 0.86, 1.46; P = 0.39; I (2) = 2 %, low confidence), mortality (RR 1.05; 95 % CI 0.87, 1.27; P = 0.61; I (2) = 0 %, moderate confidence), or ICU length of stay (mean difference (MD), -0.38 days; 95 % CI -1.49, 0.74; P = 0.51; I (2) = 30 %, low confidence). No RCT reported Clostridium difficile infection.
conclusionsPPIs were superior to H2RAs in preventing clinically important and overt GI bleeding, without significantly increasing the risk of pneumonia or mortality. Their impact on Clostridium difficile infection is yet to be determined.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.