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Meta-analysis: the efficacy of intravenous H2-receptor antagonists in bleeding peptic ulcer Levine JE; Leontiadis GI; Sharma VK; Howden CWAliment Pharmacol Ther 2002[Jun]; 16 (6): 1137-42BACKGROUND: Although a previous meta-analysis found that intravenous H2-receptor antagonists were only weakly beneficial in bleeding gastric ulcer and of no benefit in bleeding duodenal ulcer, patients with ulcer bleeding continue to receive such treatment. AIM: To re-evaluate the efficacy of intravenous H2-receptor antagonists in ulcer re-bleeding, surgery and mortality by updating the previous meta-analysis. METHODS: After two independent literature searches, randomized, placebo-controlled trials of intravenous H2-receptor antagonists in bleeding ulcer published between 1984 and 2000 were added to those from the initial meta-analysis. Pooled rates of re-bleeding, surgery and death were re-calculated, together with the relative risk reduction, absolute risk reduction, number needed to treat and Mantel-Haenszel odds ratio. RESULTS: Intravenous H2-receptor antagonists did not significantly reduce re-bleeding, surgery or death in bleeding duodenal ulcer. There were small but significant reductions in re-bleeding, surgery and death in bleeding gastric ulcer; the absolute risk reductions were 7.2%, 6.7% and 3.2%, respectively. CONCLUSIONS: Intravenous H2-receptor antagonists are of no value in bleeding duodenal ulcer, although they may be mildly beneficial in bleeding gastric ulcer. Because proton pump inhibitors have a greater inhibitory effect on gastric acid secretion than H2-receptor antagonists, they may be more effective in ulcer bleeding and should be further evaluated for that indication.|Histamine H2 Antagonists/administration & dosage/*pharmacology[MESH]|Humans[MESH]|Infusions, Intravenous[MESH]|Peptic Ulcer Hemorrhage/*drug therapy/pathology[MESH]|Peptic Ulcer/*drug therapy/mortality/surgery[MESH]|Prognosis[MESH]|Recurrence[MESH]|Risk Factors[MESH] |
