Editorial
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Meta-Anal. Mar 31, 2019; 7(3): 72-76
Published online Mar 31, 2019. doi: 10.13105/wjma.v7.i3.72
Gastrointestinal stress ulcer prophylaxis in the intensive care unit, where is the data?
Abbas Alshami, Sheily Vianney Barona, Joseph Varon, Salim Surani
Abbas Alshami, Sheily Vianney Barona, Dorrington Medical Associates, Houston, TX 77030, United States
Abbas Alshami, University of Baghdad College of Medicine, Baghdad 12114, Iraq
Sheily Vianney Barona, Benemerita Universidad Autonoma de Puebla, Puebla 72000, Mexico
Joseph Varon, United General Hospital, 7501 Fanin Street Houston, TX 77054, United States
Joseph Varon, Critical Care Services, United Memorial Medical Center, Houston, TX 77091, United States
Joseph Varon, Acute and Continuing Care, University of Texas Health Science Center at Houston, Houston, TX 77030, United States
Joseph Varon, Medicine, University of Texas Medical Branch at Galveston Houston, Galveston, TX 77555, United States
Salim Surani, Department of Pulmonary, Critical Care and Sleep Medicine, Texas A&M University, Health Science Center, Bryan, TX 77807, United States
Salim Surani, Pulmonary and Critical Care Fellowship Program, Bay Area Medical Center, Marinette, WI 54143, United States
Salim Surani, Medical Critical Care Services, Christus Spohn Hospitals-Corpus Christi, Corpus Christi, TX 78404, United States
Author contributions: All authors have contributed to the preparation of the manuscript, search and review of the editorial.
Conflict-of-interest statement: None of the authors have any conflict of interest to disclose.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Salim Surani, MD, MPH, MSHM, FACP, FCCP, FAASM, Professor, Medical Critical Care Services, Christus Spohn Hospitals-Corpus Christi, 701 Ayers St, Corpus Christi, TX 78404, United States. srsurani@hotmail.com
Telephone: +1-361- 8857722
Received: January 25, 2019
Peer-review started: January 25, 2019
First decision: February 21, 2019
Revised: March 27, 2019
Accepted: March 27, 2019
Article in press: March 28, 2019
Published online: March 31, 2019
Processing time: 4 Days and 5.8 Hours
Abstract

Stress-induced gastrointestinal ulcers are common among patients admitted to the intensive care unit (ICU). These ulcers impose significant morbidity and mortality, therefore, stress ulcer prophylaxis (SUP) is a common clinical practice among healthcare providers dealing with these critically-ill patients. Several strategies for SUP have been suggested over the past four decades, with acid suppressive therapies being the most commonly used in the ICU. Whether SUP is effective and safe, or not, remains a topic of controversy. The data is still conflicting, and provision of a simple answer is not feasible at the present time. Recently, a large phase IV, multicenter, randomized clinical trial (SUP-ICU), negated the benefits (and harms) of proton pump inhibitors as SUP. This article reviews some of these controversies.

Keywords: Gastrointestinal stress ulcers; Proton pump inhibitors; H2-antagonists; Prophylaxis; Complications

Core tips: Stress ulcer prophylaxis (SUP) is a prevalent clinical practice in patients admitted to intensive care unit (ICU). However, there is no high-quality evidence to support its use. Indeed, current data on its efficacy and complications remains conflictive at best, and until an explicit evidence becomes available, health care providers working in the ICU must carefully analyze the advantages and disadvantages of SUP based on each patient’s presentation and comorbidities.