February 24, 2020

Please Pass the Antacids – Will PEPTIC Change our Approach to ICU Stress Ulcer Prophylaxis?

Background: Critical illness and ICU admission comes with significant consequences – not just from the primary pathology but also from the secondary effects of therapies that may be begun to correct the abnormal physiology. One of these consequences in ventilated patients is the development of stress ulcers in the gastrointestinal tract, leading to bleeding. Over two-thirds of patients admitted to the ICU will be prescribed some form of stress ulcer prophylaxis, often in the form of either a proton pump inhibitor (PPI) or a histamine-2 receptor blocker (H₂RB)¹. But which one is better? Are there any risks? The existing evidence of benefit of one over another is limited. Though one systematic review did show a benefit of PPIs, the reviewed data was limited². Neither drug is without risk either. These include a potential for immunosuppression and increased risk of infections³. More evidence is needed – which is where the Proton Pump Inhibitors vs Histamine-2 Receptor Blockers for Ulcer Prophylaxis Treatment in the Intensive Care Unit (PEPTIC) randomized clinical trial comes in⁴....Read More