Comparison of proton pump inhibitors and histamine 2 receptor antagonists for stress ulcer prophylaxis in the intensive care unit

• Published in: Scientific reports 2021-09, Vol.11 (1), p.18467-18467, Article 18467
• Main Authors: Song, Myung Jin, Kim, Seok, Boo, Dachung, Park, Changhyun, Yoo, Sooyoung, Yoon, Ho Il, Cho, Young-Jae
• Format: Article
• Language: English
• Subjects: 692/308/409; 692/699/1503/197/1546; Adverse events; Aged; Anti-Ulcer Agents - administration & dosage; Anti-Ulcer Agents - adverse effects; Anti-Ulcer Agents - therapeutic use; Bleeding; Clostridium Infections - epidemiology; Clostridium Infections - etiology; Critical Care; Disease prevention; Female; Histamine; Histamine Antagonists - administration & dosage; Histamine Antagonists - adverse effects; Histamine Antagonists - therapeutic use; Humanities and Social Sciences; Humans; Intensive care; Male; Middle Aged; multidisciplinary; Patients; Peptic Ulcer Hemorrhage - drug therapy; Peptic Ulcer Hemorrhage - prevention & control; Pneumonia - epidemiology; Pneumonia - etiology; Prophylaxis; Proton pump inhibitors; Proton Pump Inhibitors - administration & dosage; Proton Pump Inhibitors - adverse effects; Proton Pump Inhibitors - therapeutic use; Science; Science (multidisciplinary); Ulcers
• ISSN: 2045-2322; 2045-2322
• DOI: 10.1038/s41598-021-98069-7

Proton pump inhibitors (PPIs), followed by histamine 2 receptor antagonists (H2RAs), are the most commonly used drugs to prevent gastrointestinal bleeding in critically ill patients through stress ulcer prophylaxis. The relative efficacy and drug-related adverse events of PPIs and H2RAs remain unclear. In this retrospective, observational, comparative cohort study, PPIs and H2RAs for stress ulcer prophylaxis in critically ill patients were compared using a common data model. After propensity matching, 935 patients from each treatment group (PPI or H2RA) were selected. The PPI group had a significantly higher 90-day mortality than the H2RA group (relative risk: 1.28; P  = 0.01). However, no significant inter-group differences in the risk of clinically important gastrointestinal bleeding were observed. Moreover, there were no significant differences between the groups concerning the risk of pneumonia or Clostridioides difficile infection, which are known potential adverse events related to these drugs. Subgroup analysis of patients with high disease severity were consistent with those of the total propensity score-matched population. These findings do not support the current recommendations, which prefer PPIs for gastrointestinal bleeding prophylaxis in the intensive care unit.