Efficacy and safety of proton pump inhibitors (ppis) for stress ulcer prophylaxis: a systematic review
Abstract
Introduction: Stress ulcer prophylaxis is widely used in critically ill patients to prevent clinically relevant gastrointestinal bleeding. Proton pump inhibitors (PPIs), such as omeprazole and esomeprazole, are commonly used in this practice. However, their indiscriminate use has been associated with adverse events, including Clostridioides difficile infections and nosocomial pneumonia, as well as uncertainties regarding their benefits in non-critical populations. Objective: To evaluate the efficacy and safety of PPIs for the prophylaxis of clinically relevant gastrointestinal bleeding in critically ill and non-critically ill patients. Methods: A systematic review without meta-analysis was conducted according to PRISMA guidelines. The PubMed, Web of Science, Virtual Health Library (VHL), CAPES Journals, LILACS, and EMBASE databases were searched. The study was registered in PROSPERO (CRD442025640517), using the descriptors “Prophylaxis”, “Stress Ulcer”, “Critical Care”, and “Proton Pump Inhibitor”. Studies published in English and Portuguese between 2014 and 2024 were included. Results: PPIs demonstrated benefits in reducing gastrointestinal bleeding among high-risk critically ill patients, whereas their effectiveness in non-critical populations remains limited. Inappropriate use was associated with an increased risk of infectious complications, highlighting the importance of clinical criteria and institutional protocols. Conclusion: PPI prophylaxis should be targeted to…
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