Effect of erythromycin before endoscopy in patients presenting with variceal bleeding: a prospective, randomized, double-blind, placebo-controlled trial

Altraif, Ibrahim; Handoo, Fayaz A.; Aljumah, Abdulrahman; Alalwan, Abduljaleel; Dafalla, Mutasim; Saeed, Abdullah Mohamed; AlKhormi, Abdulrahman; Albekairy, Abdul Karim; Tamim, Hani

doi:10.1016/j.gie.2010.09.043

Cited by 72 publications

(57 citation statements)

References 15 publications

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“…Since this meta-analysis, a study reporting on the non-randomized cohort of patients with variceal bleeding from within a randomized trial found better visualization and shorter hospital stay with erythromycin, but no signifi cant decreases in transfusions or repeat endoscopy ( 16 ). A randomized comparison of erythromycin, standard-bore nasogastric (NG) tube, or erythromycin plus NG tube in 253 patients with UGIB revealed no signifi cant differences in visualization, diagnosis at fi rst endoscopy, second-look endoscopy, further bleeding, or transfusions ( 17 ).…”

Section: Recommendationsmentioning

confidence: 95%

Management of Patients With Ulcer Bleeding

Laine

Jensen

2012

American Journal of Gastroenterology

657

547

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Ulcers are the most common cause of hospitalization for upper gastrointestinal bleeding (UGIB), and the vast majority of clinical trials of therapy for nonvariceal UGIB focus on ulcer disease. Th is guideline provides recommendations for the management of patients with overt UGIB due to gastric or duodenal ulcers. "Overt" indicates that patients present with symptoms of hematemesis, melena, and/or hematochezia. We fi rst discuss the initial management of UGIB in patients without known portal hypertension, including initial assessment and risk stratifi cation, pre-endoscopic use of medications and gastric lavage, and timing of endoscopy. We then focus on the endoscopic and medical management of ulcer disease, including endoscopic fi ndings and their prognostic implications, endoscopic hemostatic therapy, post-endoscopic medical therapy and disposition, and prevention of recurrent ulcer bleeding.Each section of the document presents the key recommendations related to the section topic, followed by a summary of the supporting evidence. A summary of recommendations is provided in Table 1 .A search of MEDLINE via the OVID interface using the MeSH term " gastrointestinal hemorrhage " limited to " all clinical trials " and " meta-analysis " for years 1966 -2010 without language restriction as well as review of clinical trials and reviews known to the authors were performed for preparation of this document. Th e GRADE system was used to grade the strength of recommendations and the quality of evidence ( 1 ). Th e quality of evidence, which infl uences the strength of recommendation, ranges from " high " (further research is very unlikely to change our confi dence in the estimate of eff ect) to " moderate " (further research is likely to have an important impact on our confi dence in the estimate of eff ect and may change the estimate) to " low " (further research is very likely to have an important impact on our confi dence in the estimate of eff ect and is likely to change the estimate), and " very low " (any estimate of eff ect is very uncertain). Th e strength of a recommendation is graded as strong when the desirable eff ects of an intervention clearly outweigh the undesirable eff ects and is graded as conditional when uncertainty exists about the trade-off s ( 1 ). In addition to quality of evidence and balance between desirable and undesirable eff ects, other factors aff ecting the strength of recommendation include variability in values and preferences of patients, and whether an intervention represents a wise use of resources ( 1 ). 2. Blood transfusions should target hemoglobin ≥ 7 g / dl, with higher hemoglobins targeted in patients with clinical evidence of intravascular volume depletion or comorbidities, such as coronary artery disease (Conditional recommendation). Management of Patients With Ulcer Bleeding3. Risk assessment should be performed to stratify patients into higher and lower risk categories and may assist in initial decisions such as timing of endoscopy, time of discharge, and level of care (Cond...

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Section: Recommendationsmentioning

confidence: 95%

Management of Patients With Ulcer Bleeding

Laine

Jensen

2012

American Journal of Gastroenterology

657

547

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“…Current recommendations emphasize early risk stratification, by using validated prognostic scales. 31 It has also been shown that the prokinetics (erythromycin or metoclopramide) before endoscopyincrease the visibility during endoscopy 32 and reduces the need for repeat endoscopy, but such practice was not existing. Antifibrinolytics have been found to decrease the mortality rate in patients with non-variceal bleed, 33 but antifibrinolytics were not used in managing any of the patients.…”

Section: Discussionmentioning

confidence: 99%

Acute upper gastrointestinal bleeding in a tertiary care hospital in South India - Have we Improved the outcomes?

NR¹

2016

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Background: Since the data on acute upper gastrointestinal bleeding (UGIB) is lacking in many of the institutes of India, this study was taken up to find out the etiology, clinical features and management of patients with acute UGIB. The other aims of the study were to assess the factors associated with re-bleeding and mortality in patients with acute UGIB. Methods: This study was a hospital-based, prospective observational study, done in all patients presenting with acute upper gastrointestinal bleed, over a period of 18 months from September 2010 to February 2012. Results: There were 396 patients admitted with upper GI bleed. 17 patients (4.2%) presented twice with recurrent acute UGIB. The majority of these patients (52.3%) were in 41-60 year age group. 35.9% patients had Oesophageal Varices. The erosive mucosal disease was the commonest cause (29%) of bleeding in patients with Non-Variceal bleed. Endoscopic variceal ligation was done in 125 (30.6%) patients, sclerotherapy in 9 (2.3%) patients and 13 (3.3%) underwent adrenaline injection. Endoscopy failed to control bleeding in 4.5% of patients. The recurrent rate of bleeding during the hospital stay was 11.9%. Thirty-four (8.6%) patients' died. 362 patients went home after a mean hospital stay of 6.2 days. Conclusion: Unlike the evidence from the western studies that peptic ulcer is the commonest cause for acute UGIB; we found varices as the common cause followed by erosive mucosal disease. The recurrent rate of bleeding and mortality were 11.9% and 8.6% respectively. Factors found to be significantly associated with recurrent bleeding & mortality was chronic liver disease and those who needed multiple transfusions.There is scope in improving the outcomes of Acute UGIB.

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“…However, those researchers arbitrarily adopted this criterion, and this definition was not validated in their studies. In contrast, Altraif et al [15] used more strict criteria, defining a ''clear'' esophagus and stomach as score C15 based on a modified and expanded objective scoring system used previously by Frossard et al [15] to score four areas from 0 to 4 with the highest sum a score of 16. They selected this cutoff for a ''clear'' view based on pilot study results, and this cutoff is a considerably tight criterion, although they assessed the esophagus instead of the duodenum.…”

Section: Discussionmentioning

confidence: 99%

“…Optimal endoscopic visibility is a crucial prerequisite for UGIB patients receiving endoscopy; however, a substantial number of patients show inadequate endoscopic preparation due to residual blood and clots hampering proper endoscopic diagnosis and intervention [9][10][11]. With regard to this issue, prokinetic agents including erythromycin and metoclopramide have been tested to see whether these drugs improve endoscopic visibility by clearing the stomach of blood, clots, and food residue in several randomized trials in patients with UGIB [12][13][14][15]. A recent meta-analysis demonstrated that patients who received erythromycin were significantly more likely to have an empty stomach at the time of endoscopy compared with patients in the control group (69 vs. 39 %) [16].…”

Section: Introductionmentioning

confidence: 99%