Treatment of acute upper gastro-intestinal bleeding with cimetidine

Acid suppression in peptic ulcer haemorrhage: a 'meta-analysis'

BACKGROUND

The use of acid-decreasing agents in the management of peptic ulcer haemorrhage continues to be controversial. Most clinical trials examining the efficacy of these drugs contain small numbers of patients, making it difficult to draw conclusions about their efficacy.

METHODS

We report a meta-analysis that examined the effect of these drugs in the management of peptic ulcer haemorrhage. Included studies were located using a search of the Medline database between 1980 and 1999. Studies were published in English, randomized and controlled by a placebo group. Mantel-Haenszel and blinded random models were used in conducting the statistical processing of this meta-analysis.

RESULTS

Twenty-one randomized placebo-controlled trials were included. The total number of patients was 3566 and the mean study size was 170 (range 20-1005). Seventeen of the papers assessed the efficacy of H2-antagonists, three assessed proton pump inhibitors and one was concerned with antacid therapy. The meta-analysis showed a significant reduction in re-bleeding rates (odds ratio, OR 0.727, 0.618-0.855, P < 0.001) and surgery rates (OR 0.707, 0.582-0.859, P < 0.001) when acid decreasing agents are used for acute peptic ulcer haemorrhage. Mortality rates appear to be unaffected (OR 1.140, 0.818-1.588, P=0. 49).

CONCLUSIONS

This meta-analysis demonstrates a significant beneficial effect of acid-decreasing agents in lowering re-bleeding and surgery rates, but demonstrated no effect upon mortality.

Ingestion of formic acid-containing agents--report of three fatal cases

Three patients were treated after they had deliberately ingested domestic agents containing formic acid. The major complications included the local effects on the oropharynx, oesophagus and stomach, metabolic acidosis, derangement of clotting mechanisms with haemorrhage and shock, widespread intravascular haemolysis, disseminated intravascular coagulation and the acute onset of respiratory and renal failure. All 3 patients died between 2 and 14 days after admission. It is the authors' belief that intensive therapy from the outset to include exchange transfusion, infusion of clotting factors, high dose steroids, ventilatory support and peritoneal or haemodialysis with parenteral nutrition may perhaps offer a better chance for survival.