Erythromycin in Acute Upper Gastrointestinal Bleeding: A Meta-Analysis of Randomized Controlled Trials

Komanapalli, Sarah D.; Samji, Naga Swetha; Duvuru, Sudhir; Inaganti, Anupama; Connolly, Seán; Roy, Praveen K.

doi:10.14309/00000434-201210001-01866

Cited by 1 publication

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“…PPIs should be discontinued as soon as is possible and long-term use of PPI in the absence of peptic ulcer disease should be avoided due to the potential of an increased risk of hepatic encephalopathy, Clostridium difficile infection and spontaneous bacterial peritonitis [25 ▪ ]. Intravenous erythromycin may be given 30 min prior to endoscopy, as it has been shown to improve visualization, decrease need for repeat endoscopy, decrease overall blood transfusion requirements and decrease length of hospital stay [26].…”

Section: Pharmacological Managementmentioning

confidence: 99%

Updated strategies in the management of acute variceal haemorrhage

Edelson

Basso

Rockey

2021

Current Opinion in Gastroenterology

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Purpose of review This article reviews the most recent studies regarding the management of acute esophageal variceal haemorrhage. Recent findings New randomized control trials and meta-analyses confirmed the role of early transjugular intrahepatic portosystemic shunt (TIPS) in the management of acute variceal haemorrhage in Child-Pugh C (10–13) and B patients with active bleeding. A recent randomized controlled trial focused on the duration of vasoactive therapy showed no difference between 2 and 5 days of octreotide. A randomized trial showed decreased use of blood products for the correction of coagulopathy using a thromboelastography-guided approach (vs. conventional parameters) as well as decreased bleeding rates when compared with standard of care. A meta-analysis found that for rescue of variceal bleeding, self-expanding metallic stents were more efficacious and safer than balloon tamponade. In addition, studies showed that Child-Pugh C patients and those with hepatic vein pressure gradient more than 20 were at the highest risk of treatment failure, while model for end-stage liver disease was highly predictive of in-hospital mortality. Summary In patients with severe coagulopathy and uncontrolled bleeding, TEG-based transfusion strategies are recommended. Antibiotics should be used for all cirrhotic patients presenting with upper gastrointestinal bleeding, but should be tailored in accordance to local resistance patterns. Early TIPS for high-risk patients has been shown to have a significant survival benefit. Certain aspects of the management of variceal bleeding remain poorly studied such as the role of early TIPS in Child-B patients as well as strategies for rescue therapy in patients who are not TIPS candidates, and require further investigation.

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Section: Pharmacological Managementmentioning

confidence: 99%