SynthesisIntensive care medicine2019
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.
Synthesis in Intensive care medicine, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 31 papers, 6 of them syntheses that pooled it.
What it found
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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.
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Who cites it
31 citing papers in PubMed, 6 syntheses or guidelines pooled it, 65 citations in OpenAlex.
- Summary of the best evidence for stress ulcer prophylaxis in critically ill patients.Frontiers in medicine · 2026Pooled it
- Pharmacological interventions for preventing upper gastrointestinal bleeding in people admitted to intensive care units: a network meta-analysis.BMJ evidence-based medicine · 2025Pooled it
- Beneficial and harmful effects of tricyclic antidepressants for adults with major depressive disorder: a systematic review with meta-analysis and trial sequential analysis.BMJ mental health · 2024Pooled it
- Guidelines on optimizing the use of proton pump inhibitors: PPI stewardship.Indian journal of gastroenterology : official journal of the Indian Society of Gastroenterology · 2023Guideline
- Efficacy and safety of gastrointestinal bleeding prophylaxis in critically ill patients: systematic review and network meta-analysis.BMJ (Clinical research ed.) · 2020Pooled it
- Predictors of gastrointestinal bleeding in adult ICU patients: a systematic review and meta-analysis.Intensive care medicine · 2019Pooled it
- Trial
- Reconciling conflicting evidence on stress ulcer prophylaxis in critically ill children: a systematic review and meta-analysis.Clinical and experimental pediatrics · 2026Article
- Effect and Mechanism of Acacetin Against Stress-Induced Gastric Mucosal Damage: Network Pharmacology, Molecular Docking and Experimental Verification.Food science & nutrition · 2026Article
- Gastroprotective Effect of Artemisia herba-alba Leaf Extract in Acetic Acid-Induced Gastric Ulceration in Wistar Rats.Chemistry & biodiversity · 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
- Rosmarinic acid mitigates stress-induced gastric ulcers by targeting the ACE2/GPX4 interaction.Frontiers in pharmacology · 2026Article
- Heterogeneous treatment effects of stress ulcer prophylaxis among ICU patients at risk for gastrointestinal bleeding.BMC medicine · 2025Article
- Association between preoperative proton pump inhibitor use and postoperative acute kidney injury in patients undergoing major surgery.Renal failure · 2024Article
- Upper gastrointestinal bleeding on veno-arterial extracorporeal membrane oxygenation support.Annals of intensive care · 2024Article
- Strategies to prevent ventilator-associated pneumonia, ventilator-associated events, and nonventilator hospital-acquired pneumonia in acute-care hospitals: 2022 Update.Infection control and hospital epidemiology · 2022Article
- Randomised clinical trials in critical care: past, present and future.Intensive care medicine · 2022Review
- An assessment of burden of hospital-acquired pneumonia among abdominal surgical patients in tertiary university hospital in Serbia: A matched nested case-control study.Frontiers in medicine · 2022Article
- Comparison of proton pump inhibitors and histamine 2 receptor antagonists for stress ulcer prophylaxis in the intensive care unit.Scientific reports · 2021Observational
- The efficacy and safety of acid suppressants for gastrointestinal bleeding prophylaxis in cardiac care unit patients.Journal of gastroenterology and hepatology · 2021Article
Corrections and comments
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Authors and funding
9 authors at 1 institution in 1 country.
Funding
Abstract
purposeMost intensive care unit (ICU) patients receive stress ulcer prophylaxis. We present updated evidence on the effects of prophylactic proton pump inhibitors (PPIs) or histamine 2 receptor antagonists (H2RAs) versus placebo/no prophylaxis on patient-important outcomes in adult ICU patients.
methodsWe conducted a systematic review with meta-analysis and trial sequential analysis (TSA) of randomised clinical trials assessing the effects of PPI/H2RA versus placebo/no prophylaxis on mortality, gastrointestinal (GI) bleeding, serious adverse events (SAEs), health-related quality of life (HRQoL), myocardial ischemia, pneumonia, and Clostridium (Cl.) difficile enteritis in ICU patients.
resultsWe identified 42 trials randomising 6899 ICU patients; 3 had overall low risk of bias. We did not find an effect of stress ulcer prophylaxis on mortality [relative risk 1.03, 95% confidence interval (CI) 0.94-1.14; TSA-adjusted CI 0.94-1.14], but the occurrence of any GI bleeding was reduced as compared with placebo/no prophylaxis (0.60, 95% CI 0.47-0.77; TSA-adjusted CI 0.36-1.00). The conventional meta-analysis indicated that clinically important GI bleeding was reduced (RR 0.63, 95% CI 0.48-0.81), but the TSA-adjusted CI 0.35-1.13 indicated lack of firm evidence. The effects of stress ulcer prophylaxis on SAEs, HRQoL, pneumonia, myocardial ischemia and Cl. difficile enteritis are uncertain.
conclusionsIn this updated systematic review, we were able to refute a relative change of 20% of mortality. The occurrence of GI bleeding was reduced, but we lack firm evidence for a reduction in clinically important GI bleeding. The effects on SAEs, HRQoL, pneumonia, myocardial ischemia and Cl. difficile enteritis remain inconclusive.
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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.