Prophylactic use of acid suppressants in adult acutely ill hospitalised patients: A systematic review with meta‐analysis and trial sequential analysis

Abstract

Background Acutely ill patients are at risk of stress‐related gastrointestinal (GI) bleeding and prophylactic acid suppressants are frequently used. In this systematic review, we assessed the effects of stress ulcer prophylaxis (SUP) with proton pump inhibitors (PPIs) or histamine‐2 receptor antagonists (H2RAs) versus placebo or no prophylaxis in acutely ill hospitalised patients. Methods We conducted the review according to the PRISMA statement, the Cochrane Handbook and GRADE, using conventional meta‐analysis and trial sequential analysis (TSA). The primary outcomes were all‐cause mortality, clinically important GI bleeding and serious adverse events (SAEs). The primary analyses included overall low risk of bias trials. Results We included 65 comparisons from 62 trials (n = 9713); 43 comparisons were from intensive care units. Only three trials (n = 3596) had overall low risk of bias. We did not find an effect on all‐cause mortality (RR 1.03, 95% CI 0.94 to 1.14; TSA‐adjusted CI 0.90 to 1.18; high certainty). The rate of clinically important GI bleeding was lower with SUP (RR 0.62, 95% CI 0.43 to 0.89; TSA‐adjusted CI 0.14 to 2.81; moderate certainty). We did not find a difference in pneumonia rates (moderate certainty). Effects on SAEs, Clostridium difficile enteritis, myocardial ischaemia and health‐related quality of life (HRQoL) were inconclusive due to sparse data. Analyses of all trials regardless of risk of bias were consistent with the primary analyses. Conclusions We did not observe a difference in all‐cause mortality or pneumonia with SUP. The incidence of clinically important GI bleeding was reduced with SUP, whereas any effects on SAEs, myocardial ischaemia, Clostridium difficile enteritis and HRQoL were inconclusive. Study registration PROSPERO registration number CRD42017055676; published study protocol: Marker, et al 2017 in Systematic Reviews.

Analysis of the Effect of Proton Pump Inhibitors on the Course of Common COVID-19

“…They suggested that the increased incidence of pneumonia caused by PPIs was due to confounders, and proton pump itself was not an independent factor affecting the occurrence of pneumonia. [13][14][15][16] According to our study, the PPIs use had no relation with the duration of the SARS-CoV-2 clearance and the hospital stay. We preferred the opinion that the PPIs use did not increase the probability of pneumonia.…”

“…They believed that the increased incidence of pneumonia caused by PPIs was due to confounding factors, and PPIs itself was not an independents factor affecting the occurrence of pneumonia. [13][14][15][16] In addition, studies have shown that PPIs can effectively inhibit virus and can be tried to treat viral infection and respiratory disease. [17][18] It is not clear whether PPIs will have a signi cant impact on COVID-19.…”

Analysis of the effect of proton pump inhibitors on the course of common COVID-19

“…They suggested that the increased incidence of pneumonia caused by PPIs was due to confounders, and proton pump itself was not an independent factor affecting the occurrence of pneumonia. [13][14][15][16] According to our study, the PPIs use has no relation with the duration of SARS-CoV-2 clearance and hospital stay by Cox regression and the propensity score method. We prefer the opinion that the PPIs use does not increase the probability of pneumonia.…”

“…They believed that the increased incidence of pneumonia caused by PPIs was due to confounding factors, and PPIs itself was not an independents factor affecting the occurrence of pneumonia. [13][14][15][16] Basic studies have shown that PPIs can effectively inhibit virus-specific serine proteases and thus play an antiviral role. [17] And H+/K+-ATPase inhibitors can be tried to treat viral infection and respiratory disease.…”

“…days in the PPIs group and 20(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26) days in the control group. There was no significant difference between the two groups in the cumulative incidence of discharge for COVID-19 cases, P=0.812.…”