Somatostatin or octreotide compared with H2 antagonists and placebo in the management of acute nonvariceal upper gastrointestinal hemorrhage: a meta-analysis.
OBJECTIVE
To determine the efficacy of somatostatin or octreotide for the treatment of acute nonvariceal upper gastrointestinal hemorrhage.


METHODS
Database searches of English-language articles published between 1966 and 1996 and the bibliographies of all related articles and textbook chapters.


METHODS
Randomized clinical trials comparing somatostatin or octreotide with H2 blockers or placebo in patients with a clinical or endoscopic diagnosis of acute nonvariceal upper gastrointestinal hemorrhage.


METHODS
Methods and quality of the studies were evaluated, and quantitative data on outcomes, including continued bleeding, rebleeding during the treatment period, need for surgery, and transfusion requirement, were extracted.


RESULTS
Among 1829 patients from 14 trials, the relative risk (RR) for continued bleeding or rebleeding was 0.53 (95% CI, 0.43 to 0.63) in favor or somatostatin, with a number needed to treat (NNT) of 5. Among 7 investigator-blinded trials, the relative risk was 0.73 (CI, 0.64 to 0.81) and the NNT was 11. Somatostatin was efficacious for peptic ulcer bleeding (RR, 0.48 [CI, 0.39 to 0.59]; NNT, 4) and showed a trend toward efficacy for non-peptic ulcer bleeding (RR, 0.62 [CI, 0.39 to 1.002]). Although the overall results suggested a decreased need for surgery in the somatostatin group, a subgroup analysis of investigator-blinded trials revealed a more modest effect that was not statistically significant (RR, 0.94 [CI, 0.87 to 1.001]).


CONCLUSIONS
Somatostatin may reduce the risk for continued bleeding from acutely bleeding peptic ulcer disease. Somatostatin may be useful either as an adjunct treatment before endoscopy or when endoscopy is unsuccessful, contraindicated, or unavailable.
Imperiale
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Roudebush Veterans Affairs, Indianapolis, Indiana USA.
Birgisson
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D000208:Acute Disease; D000368:Aged; D005260:Female; D005765:Gastrointestinal Agents / Q000627:therapeutic use*; D006471:Gastrointestinal Hemorrhage / Q000188:drug therapy*; D006635:Histamine H2 Antagonists / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015282:Octreotide / Q000627:therapeutic use*; D010919:Placebos; D012008:Recurrence; D013004:Somatostatin / Q000627:therapeutic use*
D005765:Gastrointestinal Agents; D006635:Histamine H2 Antagonists; D010919:Placebos; D013004:Somatostatin; D015282:Octreotide