Histamine H2 antagonists are widely used in treating patients with hematemesis and melena, despite the lack of reliable evidence of benefit from any of the randomized trials, considered separately. Examination of the data from all 27 available randomized trials, in which over 2500 patients were entered, suggests that treatment may reduce the rates of rebleeding, surgery, and death by about 10, 20, and 30 per cent, respectively, although these results were only marginally significant for surgery and death. Any benefit appeared to be confined to patients with bleeding gastric ulcers, but since this subgroup analysis was prompted by preliminary examination of the data in some of the individual trials reviewed here, it should be treated with particular caution. The implications of this overview are that treatment with histamine H2 antagonists appears to be moderately promising, but its effects on important end points, such as death, still need to be assessed reliably. Prevention of "only" about 20 per cent of all deaths could well be worthwhile, for the condition is common, and the treatment widely practicable. To detect such a moderate effect reliably, however, might require the randomization of 10,000 patients (or more), which would be possible only in an extremely simple multicenter collaborative trial.
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Sung, J. J.Y., Barkun, A., Kuipers, E. J., Mossner, J., Jensen, D. M., Stuart, R., Lau, J. Y., Ahlbom, H., Kilhamn, J., Lind, T., for the Peptic Ulcer Bleed Study Group,
(2009). Intravenous Esomeprazole for Prevention of Recurrent Peptic Ulcer Bleeding: A Randomized Trial. ANN INTERN MED
150: 455-464
[Abstract][Full Text]
Leontiadis, G. I., Sharma, V. K., Howden, C. W.
(2007). Proton Pump Inhibitor Therapy for Peptic Ulcer Bleeding: Cochrane Collaboration Meta-analysis of Randomized Controlled Trials. Mayo Clin Proc.
82: 286-296
[Abstract][Full Text]
Olsen, K. M.
(2005). Use of acid-suppression therapy for treatment of non-variceal upper gastrointestinal bleeding. Am J Health Syst Pharm
62: S18-S23
[Abstract][Full Text]
Leontiadis, G. I, Sharma, V. K, Howden, C. W
(2005). Systematic review and meta-analysis of proton pump inhibitor therapy in peptic ulcer bleeding. BMJ
330: 568-
[Abstract][Full Text]
Barkun, A., Bardou, M., Marshall, J. K., for the Nonvariceal Upper GI Bleeding Consensus Co,
(2003). Consensus Recommendations for Managing Patients with Nonvariceal Upper Gastrointestinal Bleeding. ANN INTERN MED
139: 843-857
[Abstract][Full Text]
Huggins, R. M, Scates, A. C, Latour, J. K
(2003). Intravenous Proton-Pump Inhibitors Versus H2-Antagonists for Treatment of GI Bleeding. The Annals of Pharmacotherapy
37: 433-437
[Abstract][Full Text]
Hawkey, G M, Cole, A T, McIntyre, A S, Long, R G, Hawkey, C J
(2001). Drug treatments in upper gastrointestinal bleeding: value of endoscopic findings as surrogate end points. Gut
49: 372-379
[Abstract][Full Text]
Lau, J. Y.W., Sung, J. J.Y., Lee, K. K.C., Yung, M.-y., Wong, S. K.H., Wu, J. C.Y., Chan, F. K.L., Ng, E. K.W., You, J. H.S., Lee, C.W., Chan, A. C.W., Chung, S.C. S.
(2000). Effect of Intravenous Omeprazole on Recurrent Bleeding after Endoscopic Treatment of Bleeding Peptic Ulcers. NEJM
343: 310-316
[Abstract][Full Text]
Libby, E. D.
(2000). Omeprazole to Prevent Recurrent Bleeding after Endoscopic Treatment of Ulcers. NEJM
343: 358-359
[Full Text]
Peterson, W. L., Cook, D. J.
(1998). Antisecretory Therapy for Bleeding Peptic Ulcer. JAMA
280: 877-878
[Full Text]
Khuroo, M. S., Yattoo, G. N., Javid, G., Khan, B. A., Shah, A. A., Gulzar, G. M., Sodi, J. S.
(1997). A Comparison of Omeprazole and Placebo for Bleeding Peptic Ulcer. NEJM
336: 1054-1058
[Abstract][Full Text]
Laine, L., Peterson, W. L.
(1994). Bleeding Peptic Ulcer. NEJM
331: 717-727
[Full Text]
L'ABBE, K. A., DETSKY, A. S., O'ROURKE, K.
(1987). Meta-Analysis in Clinical Research. ANN INTERN MED
107: 224-233
[Abstract]
Schaffner, J. A.
(1986). Acute Gastrointestinal Bleeding. J Intensive Care Med
1: 289-296
[Abstract]
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