S1362 Efficacy and Safety of Proton Pump Inhibitors Versus Histamine-2 Receptor Antagonists for Stress Ulcer Prophylaxis in Critically Ill Patients
Bibliographic record
Abstract
Introduction: Stress ulcer prophylaxis (SUP) is critical in preventing gastrointestinal (GI) bleeding in critically ill patients, who are vulnerable to stress-related mucosal damage. Proton pump inhibitors (PPIs) and histamine-2 receptor antagonists (H2RAs) are commonly used, but their comparative efficacy and safety remain debated. This systematic review and meta-analysis evaluates PPIs vs H2RAs in critically ill adults, focusing on GI bleeding prevention and associated risks. Methods: We included randomized controlled trials (RCTs) and observational studies published between January 2014 and March 2025 comparing PPIs vs H2RAs in critically ill adults requiring SUP were included. Eligible studies reported the outcomes of GI bleeding, mortality, pneumonia, and CDI. A comprehensive search across major databases was conducted in March 2025. Risk of bias was assessed using Cochrane Risk of Bias Tool (RoB 1) for RCTs and the Newcastle-Ottawa Scale for observational studies. Data extraction followed PRISMA guidelines, and meta-analysis used random-effects models, with heterogeneity assessed via the I² statistic. Results: The search yielded 6,354 studies, and 12 studies met the inclusion criteria: 4 RCTs and 8 observational studies, involving 262,701 participants. GI Bleeding: 6 studies reported that PPIs (n = 72,804) were not significantly more effective than H2RAs (n = 43,701) in preventing GI bleeding risk (OR: 1.23, 95% CI: 0.70–2.16, I² = 94%). Pneumonia: 5 studies reported that there was no statistically significant difference between PPIs (n = 13,152) and H2RAs (n = 15,155) in pneumonia risk (OR: 1.01, 95% CI: 0.84–1.21, I² = 47%). CDI: Across 6 studies, PPIs (n = 88,483) compared to H2RAs (n = 96,562) were numerically associated with a high risk of CDI but not statistically significant (OR: 1.41, 95% CI: 0.87–2.28, I² = 89%). Mortality: In 9 studies, patients receiving PPIs (n = 29,176) had a slightly higher mortality risk than those receiving H2RAs (n = 30,841) (OR: 1.17, 95% CI: 1.00–1.36, I² = 86%). Conclusion: While PPIs are often preferred for SUP, this analysis indicates no significant advantage over H2RAs in reducing GI bleeding. Moreover, their use may be associated with increased risks of CDI and mortality, warranting cautious, individualized use in critically ill patients.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.014 | 0.042 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.007 | 0.013 |
| Bibliometrics | 0.005 | 0.004 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.011 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".