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Enteral nutrition better than proton pump inhibitors?

Jalil, Bilal A.; El-Kersh, Karim

Current Opinion in Critical Care: August 2019 - Volume 25 - Issue 4 - p 334–339
doi: 10.1097/MCC.0000000000000620
METABOLIC SUPPORT: Edited by Mette M. Berger

Purpose of review Stress ulcer prophylaxis in critically-ill patients has been a subject of extensive research, with multiple clinical trials attempting to study the best method of stress ulcer prophylaxis with the least adverse effects. Until recently, pharmacologic prophylaxis has prevailed as the primary choice for the prevention of stress ulcers but recent clinical studies have attempted to evaluate the role of enteral nutrition in stress ulcer prophylaxis.

Recent findings The incidence of stress ulcers that result in clinically important gastrointestinal bleeding (CIGIB) has drastically decreased over the last two decades. Furthermore, in the current era CIGB in the ICU does not seem to be associated with an increased mortality. Multiple recent clinical studies aimed to evaluate the role of proton pump inhibitors (PPIs) in patients who tolerate enteral nutrition in the ICU.

Summary The results of multiple recent clinical studies call for re-evaluation of the routine use of PPIs in critically ill patients who tolerates enteral nutrition in the ICU. Despite the promising preliminary results, definitive recommendations need larger clinical trials that are powered to evaluate any added benefits of using PPI in critically ill patients who tolerate enteral nutrition given the low incidence of CIGB in the current era.

Division of Pulmonary, Critical Care, and Sleep Disorders Medicine, Department of Internal Medicine, University of Louisville, Louisville, Kentucky, USA

Correspondence to Karim El-Kersh, MD, Division of Pulmonary, Critical Care and Sleep Disorders Medicine, 550 S. Jackson Street, ACB, A3R43, Louisville, KY 40202, USA. Tel: +1 502 553 0186; fax: +1 502 852 1359; e-mail: karim.elkersh@louisville.edumailto

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