| Stress ulcer prophylaxis in the critically ill: a meta-analysis. | |
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MedLine Citation:
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PMID: 1835294 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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PURPOSE: To examine the differential effect of stress ulcer prophylaxis on overt bleeding, clinically important bleeding, and mortality in critically ill patients. DATA IDENTIFICATION: Computerized bibliographic search of published and unpublished research. STUDY SELECTION: Independent review of 168 articles identified 42 relevant randomized trials for inclusion. DATA ABSTRACTION: The validity, population, intervention, and outcomes of each trial were evaluated. RESULTS: Stress ulcer prophylaxis with antacids (odds ratio 0.40 [95% confidence interval (CI) 0.20 to 0.79]) or histamine-2-receptor antagonists (odds ratio 0.29 [95% CI 0.17 to 0.45]) decreases the incidence of overt gastrointestinal bleeding. Histamine-2-receptor antagonists are more effective than antacids at reducing overt hemorrhage (odds ratio 0.56 [95% CI 0.33 to 0.97]). A significant reduction in clinically important gastrointestinal hemorrhage is evident only with histamine-2-receptor antagonist therapy. There is a trend favoring antacids over sucralfate in the outcome of clinically important bleeding (odds ratio 0.65 [95% CI 0.16 to 2.49]); however, there are insufficient data to evaluate histamine-2-receptor antagonists versus sucralfate. No difference in mortality between treated and untreated patients was found. CONCLUSIONS: Overt gastrointestinal bleeding in critically ill patients is reduced by prophylaxis with antacids or histamine-2-receptor antagonists. Histamine-2-receptor antagonists are more effective than antacids at decreasing overt bleeding and are more effective than no treatment at reducing the incidence of clinically important bleeding. Mortality rates in the intensive care unit are not decreased by stress ulcer prophylaxis. |
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Authors:
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D J Cook; L G Witt; R J Cook; G H Guyatt |
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Publication Detail:
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Type: Journal Article; Meta-Analysis |
Journal Detail:
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Title: The American journal of medicine Volume: 91 ISSN: 0002-9343 ISO Abbreviation: Am. J. Med. Publication Date: 1991 Nov |
Date Detail:
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Created Date: 1991-12-18 Completed Date: 1991-12-18 Revised Date: 2008-11-21 |
Medline Journal Info:
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Nlm Unique ID: 0267200 Medline TA: Am J Med Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: 519-27 Citation Subset: AIM; IM |
Affiliation:
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Department of Medicine, McMaster Faculty of Health Sciences, Hamilton, Ontario, Canada. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Critical Care
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methods* Gastrointestinal Hemorrhage / prevention & control Humans Meta-Analysis as Topic Peptic Ulcer / prevention & control* Stress, Physiological* |
| Comments/Corrections | |
Erratum In:
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Am J Med 1991 Dec;91(6):670 |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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