Patients who require neurocritical care risk developing stress-related ulcers in their gastrointestinal tract. For a study, researchers sought to conduct a comprehensive review and meta-analysis of stress ulcer prophylaxis (SUP) in brain injury-admitted critically sick people. Investigators compared SUP with histamine-2-receptor antagonists (H2RAs) or proton pump inhibitors (PPIs) to placebo or no prophylaxis, as well as to each other. The primary outcome in the intensive care unit was gastrointestinal bleeding (GIB). Secondary outcomes included predetermined measures such as duration of stay in the intensive care unit, the incidence of nosocomial pneumonia, and other comorbidities after 30 days. About 11 trials enrolling 930 participants were considered in the meta-analysis of 11 relevant trials, including 1,036 neurocritical care patients. H2RAs were associated with a reduced incidence of GIB compared to placebo or no prophylaxis (Risk ratio [RR] 0.42, 95% CI 0.30–0.58; P<0.001); PPIs were associated with a lower risk of GIB compared to placebo/no prophylaxis (RR 0.37, 95% CI 0.23–0.59). No significant difference in GIB was seen between PPIs and H2RAs (RR 0.53; 95% CI 0.26–1.06; P=0.07; I2 = 0%). The overall high or uncertain risk of bias in individual studies, the low event rates, and the small sample sizes made it difficult to draw solid clinical conclusions about SUP’s efficacy in patients receiving neurocritical care.

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