Efficacy and safety of pantoprazole for stress-ulcer prophylaxis in critically ill patients: A systematic review and Meta-analysis of randomized controlled trials.

Rahul Falodia; Rabia Ramzan; Tahir Mehmood Khan; Huzaifa Sabir Nawaz; Muhammad Affan; Mohammad Aitzaz Hassan; Zarhaish Barkat-Ullah

doi:10.1016/j.jcrc.2026.155712

PubMed · 42594423

Efficacy and safety of pantoprazole for stress-ulcer prophylaxis in critically ill patients: A systematic review and Meta-analysis of randomized controlled trials.

Rahul Falodia·Rabia Ramzan·Tahir Mehmood Khan·Huzaifa Sabir Nawaz·Muhammad Affan·Mohammad Aitzaz Hassan·Zarhaish Barkat-Ullah

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Abstract

BACKGROUND: Stress-related mucosal damage (SRMD) is common in critically ill patients, and pharmacologic prophylaxis remains essential. This study evaluated the efficacy and safety of pantoprazole for stress-ulcer prophylaxis in ICU patients. MATERIALS AND METHODS: A systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted per PRISMA-2020 guidelines. PubMed, Scopus, and CENTRAL were searched for studies comparing pantoprazole with placebo in adult and pediatric ICU patients. The primary outcome was clinically important gastrointestinal (GI) bleeding; secondary outcomes included mortality, ventilator-associated pneumonia (VAP), and Clostridioides difficile infection. RESULTS: Seven RCTs (n ≈ 9127; pantoprazole = 4575; placebo = 4552) were included. Pantoprazole significantly reduced clinically important GI bleeding (RR = 0.53; 95% CI 0.29-0.94; p = 0.03) without affecting overall mortality (RR ≈ 0.99 [95% CI 0.92-1.05]; p = 0.68). Infection rates were similar between groups (VAP: RR = 0.99; p = 0.78; C. difficile: RR = 1.11; p = 0.73). Sensitivity analyses confirmed robustness. CONCLUSIONS: Pantoprazole effectively reduces clinically important GI bleeding without increasing infection or overall mortality.

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Pantoprazole Humans Critical Illness Randomized Controlled Trials as Topic Anti-Ulcer Agents Gastrointestinal Hemorrhage Pneumonia, Ventilator-Associated Peptic Ulcer Intensive Care Units Stress, Psychological Gastrointestinal bleeding Intensive care Stress-ulcer prophylaxis Ventilator-associated pneumonia meta-analysis Journal Article Systematic Review Meta-Analysis Review

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Rahul Falodia, Rabia Ramzan, Tahir Mehmood Khan, Huzaifa Sabir Nawaz, Muhammad Affan, Mohammad Aitzaz Hassan, Zarhaish Barkat-Ullah. 2026-08-13. Efficacy and safety of pantoprazole for stress-ulcer prophylaxis in critically ill patients: A systematic review and Meta-analysis of randomized controlled trials.. https://doi.org/10.1016/j.jcrc.2026.155712

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Anti-Ulcer Agents subject Critical Illness subject Gastrointestinal Hemorrhage subject Gastrointestinal bleeding subject Humans subject Intensive Care Units subject Intensive care subject Journal Article subject Journal Article; Systematic Review; Meta-Analysis; Review resource Meta-Analysis subject Pantoprazole subject Peptic Ulcer subject Systematic reviews study

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