The efficacy and safety of acid suppressants for gastrointestinal bleeding prophylaxis in cardiac care unit patients

Chen, Chen; Liu, Hui; Duan, Ruqiao; Wang, Fangfang; Duan, Liping

doi:10.1111/jgh.15432

Cited by 4 publications

(2 citation statements)

References 44 publications

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“…[13][14][15] Although PPIs are considered relatively safe, some case-control studies suggest that their use may be associated with an increased risk of respiratory tract infections 7 and CAP in adults and children and even hospitalization for pneumonia. 16 However, the specific mechanism is still not fully elaborated, and the effect of PPIs on CAP is still controversial. Therefore, it is necessary to perform a metaanalysis to comprehensively and systematically understand the effect of PPIs on CAP.…”

Section: Introductionmentioning

confidence: 99%

Proton Pump Inhibitors and the Risk of Community-Acquired Pneumonia: An Updated Meta-analysis

Xun

Yin

et al. 2021

Ann Pharmacother

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Background: Some studies suggested an increased risk of community-acquired pneumonia (CAP) among proton pump inhibitors (PPI) users. However, the published evidence is inadequate to define the association between PPI use and the risk of CAP. Objective: The aims of our meta-analysis were to systematically assess the association between the risk of CAP and PPI use in adults to reduce the adverse effects of PPI and ensure the safety of medication for patients. Methods: A comprehensive literature search was conducted, published between January 1, 2004, and February 1, 2021. The primary outcome was the incidence of CAP. This meta-analysis was performed using odds ratios (ORs) with 95% CIs as effective measures; 13 studies including 2 098 804 patients were enrolled in our meta-analysis. Results: Our study revealed that the incidence of CAP was higher in PPI users than non -PPI users [OR = 1.37 (95% CI = 1.22–1.53)], especially for PPI duration < 30 days [OR = 1.49 (95% CI = 1.34–1.66)]. Compared with non-PPI use, PPI use increased the incidence of CAP in the stroke disease population [OR = 1.52 (95% CI = 1.33–1.75)], but not in the liver disease population [OR = 1.13 (95% CI = 0.98–1.30)]. Conclusions and Relevance: Using PPI could increase the risk of CAP when compared to not using PPI. PPI use increased the incidence of CAP in patients with stroke. Clinicians and clinical pharmacists should weigh the benefits before medication and strictly control the indication of the prescription, so as to reduce adverse reactions.

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Section: Introductionmentioning

confidence: 99%

Proton Pump Inhibitors and the Risk of Community-Acquired Pneumonia: An Updated Meta-analysis

Xun

Yin

et al. 2021

Ann Pharmacother

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“…One large retrospective study described an increase in delirium in patients exposed to H2RAs or PPIs compared to controls who were not receiving either medication [12]. Some studies have shown an association between PPIs and infectious complications [13,14]. Pooled analyses, however, have been inconsistent [5 ▪ ,11 ▪ ,15].…”

Section: Medications Used For Stress Ulcer Prophylaxismentioning

confidence: 99%

Prophylactic acid suppression and enteral nutrition

Barletta¹

2022

Current Opinion in Clinical Nutrition &Amp; Metabolic Care

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Purpose of reviewStress ulcer prophylaxis (SUP) is routinely administered to critically ill patients who are at high-risk for clinically important gastrointestinal bleeding. Recent evidence however has highlighted adverse effects with acid suppressive therapy, particularly proton pump inhibitors where associations with higher mortality have been reported. Enteral nutrition may provide benefits in reducing the incidence of stress ulceration and may mitigate the need for acid suppressive therapy. This manuscript will describe the most recent evidence evaluating enteral nutrition for the provision of SUP.Recent findingsThere are limited data evaluating enteral nutrition for SUP. The available studies compare enteral nutrition with or without acid suppressive therapy rather than enteral nutrition vs. placebo. Although data exist demonstrating similar clinically important bleeding rates in patients on enteral nutrition who receive SUP vs. no SUP, these studies are underpowered for this endpoint. In the largest placebo-controlled trial conducted to date, lower bleeding rates were observed with SUP and most patients were receiving enteral nutrition. Pooled analyses had also described benefit with SUP vs. placebo and enteral nutrition did not change the impact of these therapies.SummaryAlthough enteral nutrition may provide some benefit as SUP, existing data are not strong enough to validate their use in place of acid suppressive therapy. Clinicians should continue to prescribe acid suppressive therapy for SUP in critically ill patients who are at high risk for clinically important bleeding even when enteral nutrition is being provided.

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The benefit of omeprazole exposure on all-cause mortality and length of ICU/hospital stay might vary with age in critically ill pediatric patients: A cohort study

Jiang,

Guo,

Zhang

et al. 2023

Eur J Clin Pharmacol

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The efficacy and safety of acid suppressants for gastrointestinal bleeding prophylaxis in cardiac care unit patients

Cited by 4 publications

References 44 publications

Proton Pump Inhibitors and the Risk of Community-Acquired Pneumonia: An Updated Meta-analysis

Proton Pump Inhibitors and the Risk of Community-Acquired Pneumonia: An Updated Meta-analysis

Prophylactic acid suppression and enteral nutrition

The benefit of omeprazole exposure on all-cause mortality and length of ICU/hospital stay might vary with age in critically ill pediatric patients: A cohort study

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