Meta-analysis: the efficacy of intravenous H2-receptor antagonists in bleeding peptic ulcer.
BACKGROUND
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.


OBJECTIVE
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.
Levine
J E
JE
Department of Medicine, Evanston Hospital, Evanston, IL, USA.
Leontiadis
G I
GI
Sharma
V K
VK
Howden
C W
CW
D006635:Histamine H2 Antagonists / Q000008:administration & dosage / Q000494:pharmacology*; D006801:Humans; D007262:Infusions, Intravenous; D010437:Peptic Ulcer / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery; D010438:Peptic Ulcer Hemorrhage / Q000188:drug therapy* / Q000473:pathology; D011379:Prognosis; D012008:Recurrence; D012307:Risk Factors
D006635:Histamine H2 Antagonists