Prophylactic acid suppression and enteral nutrition

Area of Science:

• Critical care medicine
• Gastroenterology
• Pharmacology

Background:

• Stress ulcer prophylaxis (SUP) is standard for critically ill patients at high risk of gastrointestinal bleeding.
• Concerns exist regarding adverse effects of acid suppressive therapy (AST), including proton pump inhibitors (PPIs), with reported associations to increased mortality.
• Enteral nutrition (EN) is being investigated as a potential alternative or adjunct for SUP.

Approach:

• This review synthesizes recent evidence on the efficacy of EN for stress ulcer prophylaxis.
• Studies comparing EN with or without AST were analyzed, focusing on clinically important gastrointestinal bleeding rates.
• The impact of EN on the effectiveness of AST for SUP was evaluated.

Key Points:

• Limited data exist specifically evaluating EN as a standalone SUP strategy.
• Existing studies suggest similar bleeding rates between EN with and without AST, but are often underpowered.
• The largest placebo-controlled trial indicated lower bleeding rates with SUP, with most patients receiving EN.

Conclusions:

• While EN may offer some benefits for SUP, current evidence is insufficient to replace AST.
• Clinicians should continue to prescribe AST for SUP in high-risk critically ill patients, even when EN is administered.