P2688 - Enteral Nutrition Alone as a Stress Ulcer Prophylaxis in Mechanically Ventilated Patients: A Meta-Analysis of Randomized Controlled Trials

Aamir Saeed, MD¹, Saira Yousuf, MD¹, Marjan Haider, MD², Ghulam Ali Hasnan, MBBS³, Hina Akbar, MD⁴, Sachit Sharma, MD⁵, Umar Hayat, MD⁶, Manesh Kumar Gangwani, MD⁷, Muhammad Hashim Hayat, MD⁸, Umer Farooq, MD⁹, Muhammad Aziz, MBBS¹⁰, Mark Radlinski, MD¹, Faisal Kamal, MD¹¹
1Vanderbilt University Medical Center, Nashville, TN; 2Trinity Health Ann Arbor Hospital, Ypsilanti, MI; 3Dr Grays Hospital NHS Grampian, Elgin, Scotland, United Kingdom; 4King Edward Medical University, Chattanooga, TN; 5Richmond Gastroenterology Associates, Richmond, VA; 6Geisinger Wyoming Valley Medical Center, Wilkes-Barre, PA; 7University of Arkansas for Medical Sciences, Little Rock, AR; 8Brigham and Women's Hospital, Harvard Medical School, Boston, MA; 9Saint Louis University, Saint Louis, MO; 10Bon Secours Mercy Health, Toledo, OH; 11Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA

Introduction: Some early reports found that early enteral nutrition (EN) may be as effective as pharmacologic stress ulcer prophylactic (SUP) agents in preventing gastrointestinal (GI) bleeding in mechanically ventilated patients. We conducted a meta-analysis of randomized control trials (RCTs) to compare outcomes of EN plus pharmacological SUP vs. EN alone in mechanically ventilated patients.

Methods: Several databases were reviewed to identify studies com comparing EN plus pharmacological SUP and EN alone in preventing GI bleeding in mechanically ventilated patients, from inception to November 01, 2024. The databases searched included PubMed, Web of Science Core Collection, Embase, and the Cochrane Database of Systematic Reviews. Our outcomes of interest were GI bleeding, overall mortality, Clostridium difficile infection (CDI), and ventilator-associated pneumonia (VAP). We calculated risk ratios (RRs) with 95% confidence intervals (CIs) for all the outcomes. Data was analyzed using random effect model. Heterogeneity was assessed using the I² statistic.

Results: Five studies comprising 498 patients (EN plus pharmacological SUP 251 patients and EN alone 247 patients) met the inclusion criteria. We only included patients requiring mechanical ventilation. We found no significant difference in rate of GI bleeding between groups, RR (95% CI): 0.93 (0.24, 3.70), p=0.92 (Figure 1). There was no significant difference in VAP, RR (95% CI): 1.38 (0.70, 2.72),p=0.36 (Figure 2), overall mortality, RR (95% CI): 1.29 (0.91, 1.82),p=0.16, and C. diff infection rate, RR (95% CI): 0.70 (0.07, 6.72),p=0.76 between groups.

Discussion: Our meta-analysis found no significant difference in outcomes in mechanically ventilated patients who received EN plus pharmacological stress ulcer prophylaxis vs. EN alone. Our findings suggest initiating early enteral nutrition in mechanically ventilated patients.


Figure: Figure 1: Comparison of GI bleeding between the groups


Figure: Figure 2: Comparison of VAP between the groups


Disclosures:
Aamir Saeed indicated no relevant financial relationships.
Saira Yousuf indicated no relevant financial relationships.
Marjan Haider indicated no relevant financial relationships.
Ghulam Ali Hasnan indicated no relevant financial relationships.
Hina Akbar indicated no relevant financial relationships.
Sachit Sharma indicated no relevant financial relationships.
Umar Hayat indicated no relevant financial relationships.
Manesh Kumar Gangwani indicated no relevant financial relationships.
Muhammad Hashim Hayat indicated no relevant financial relationships.
Umer Farooq indicated no relevant financial relationships.
Muhammad Aziz indicated no relevant financial relationships.
Mark Radlinski indicated no relevant financial relationships.
Faisal Kamal indicated no relevant financial relationships.

Aamir Saeed, MD¹, Saira Yousuf, MD¹, Marjan Haider, MD², Ghulam Ali Hasnan, MBBS³, Hina Akbar, MD⁴, Sachit Sharma, MD⁵, Umar Hayat, MD⁶, Manesh Kumar Gangwani, MD⁷, Muhammad Hashim Hayat, MD⁸, Umer Farooq, MD⁹, Muhammad Aziz, MBBS¹⁰, Mark Radlinski, MD¹, Faisal Kamal, MD¹¹. P2688 - Enteral Nutrition Alone as a Stress Ulcer Prophylaxis in Mechanically Ventilated Patients: A Meta-Analysis of Randomized Controlled Trials, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.