Effects of oral/enteral nutrition alone versus plus pantoprazole on gastrointestinal bleeding in critically ill patients with low risk factor: a multicenter, randomized controlled trial

Abstract

Background/aim: Critically ill patients are at risk of developing gastrointestinal (GI) bleeding due to stress causing mucosal damage.Aim of the study was to determine the effect of oral/enteral nutrition with or without concomitant pantoprazole on upper GI bleedingin low risk critically ill patients.Materials and methods: This was a prospective, randomized, open-label, multicenter study conducted with intensive care unit (ICU)patients receiving oral/enteral nutritional support. Patients were randomly assigned into two groups including intervention group(received oral/EN plus pantoprazole) and control group (received only oral/EN).Results: A total of 300 patients (intervention group: 152, control group: 148) participated in the study. Overall, 226 (75%) patients werefed by orally and 74 (25%) patients fed by enteral tube feeding. Median duration of nutritional support 4 (range: 2–33) days. Overt upperGI bleeding was noted only in one patient (0.65%) who was in the intervention group. The overall length of ICU stay of 4 (2–105) days,while ICU stay was significantly longer in the intervention group than in the control group (P = 0.006).Conclusions: Our findings seems to indicate that in patients who are at low risk for GI bleeding and under oral/enteral nutritionalsupport, the use of PPIs may not reduce the risk of bleeding, however these results are imprecise because of low event (GI bleeding) rateand limited power.