title: Erythromycin prior to endoscopy in acute upper gastrointestinal bleeding: a meta-analysis.
abstract: OBJECTIVE
  Upper gastrointestinal bleeding (UGIB) is a medical emergency requiring urgent endoscopy and diagnosis. However, adequate visualization is a necessity. Studies have been performed evaluating the efficacy of erythromycin infusion prior to endoscopy to improve visibility and therapeutic potential of esophagogastroduodenoscopy (EGD) with varied results. Therefore, a meta-analysis was performed comparing the efficacy of erythromycin infusion prior to endoscopy in acute UGIB.
  
  
  METHODS
  Multiple databases were searched. Meta-analysis for the effect of erythromycin prior to endoscopy in UGIB was analyzed by calculating pooled estimates of visualization of gastric mucosa, need for second endoscopy, and units of blood transfused using odds ratio (OR) and weighted mean difference (WMD).
  
  
  RESULTS
  Four studies (N = 269) met the inclusion criteria. Erythromycin prior to endoscopy in UGIB demonstrated a statistically significant improvement in visualization of the gastric mucosa (OR 4.89; 95% CI 2.85-8.38, p < 0.01), a decrease in the need for a second endoscopy (OR 0.42; 95% CI 0.24-0.74, p < 0.01), and a trend for less units of blood transfused (WMD -0.48; 95% CI -0.97 to 0.01, p = 0.05) with erythromycin as compared with no erythromycin.
  
  
  CONCLUSIONS
  Erythromycin infusion prior to endoscopy in acute UGIB significantly improves visualization of gastric mucosa while decreasing the need for a second endoscopy. Based upon these results, erythromycin should be strongly considered prior to endoscopy in patients with UGIB.
authors.affiliation: Division of Gastroenterology, University of Missouri School of Medicine, Columbia, MO, USA.
authors.forename: Nicholas M
authors.initials: NM
authors.lastname: Szary
authors.forename: Ruchi
authors.initials: R
authors.lastname: Gupta
authors.forename: Abhishek
authors.initials: A
authors.lastname: Choudhary
authors.forename: Michelle L
authors.initials: ML
authors.lastname: Matteson
authors.forename: Murtaza
authors.initials: M
authors.lastname: Arif
authors.forename: Hazem T
authors.initials: HT
authors.lastname: Hammad
authors.forename: Matthew L
authors.initials: ML
authors.lastname: Bechtold
mesh_terms: D000208:Acute Disease; D001803:Blood Transfusion; D016145:Endoscopy, Digestive System / Q000379:methods; D004917:Erythromycin / Q000494:pharmacology; D005746:Gastric Emptying / Q000187:drug effects; D005753:Gastric Mucosa; D005765:Gastrointestinal Agents; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis*; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D007262:Infusions, Intravenous; D016032:Randomized Controlled Trials as Topic; D011964:Receptors, Gastrointestinal Hormone / Q000819:agonists; D018013:Receptors, Neuropeptide / Q000819:agonists; D013272:Stomach Diseases / Q000175:diagnosis*
chemical_list: D005765:Gastrointestinal Agents; D011964:Receptors, Gastrointestinal Hormone; D018013:Receptors, Neuropeptide; C050802:motilin receptor; D004917:Erythromycin