Systematic Review and Net-Work Meta-Analysis of Upper Gastrointestinal Hemorrhage Interventions

Abstract

Background/Aims: Upper gastrointestinal hemorrhage (UGH) is a serious medical condition which affects a large number of individuals. Endoscopic therapy accompanied by medication is a standard approach that is used to improve the prognosis of UGH patients and a few medications have been developed including proton pump inhibitors (PPIs), histamine H₂ receptor antagonist (H2RA), somatostatin analogues and tranexamic acid. This study is set to compare the efficacy and safety of various medical interventions that are used to manage upper gastrointestinal bleeding. Methods: We searched PubMed, Cochrane Library, and Embase for relevant articles. Eligible studies were determined by using both the inclusion and exclusion criteria. Both traditional pair-wise meta-analysis and net-work analysis were carried out to evaluate the corresponding interventions. Results and Conclusion: PPI is an effective medication for UGH patients and intravenous PPI exhibits equivalent effectiveness and safety in comparison to oral PPI. H2RA is not recommended for UGH patients as patients treated with H2RA are associated with an increased risk of adverse events including rebleeding, need for surgery and all-cause mortality. Moreover, patients treated with H2RA exhibit an increased length of average hospital stay and blood transfusion amount compared to those treated with PPI. Tranexamic acid is also considered as another promising medication for UGH.

Diagnosis and Treatment of Peptic Ulcer in Adults (Clinical Guidelines of the Russian Gastroenterological Association, Russian Society of Colorectal Surgeons and the Russian Endoscopic Society)

“…• Пациентам с лабораторно и эндоскопически подтвержденным язвенным кровотечением с целью его остановки в рамках других мероприятий по достижению гемостаза рекомендуется внутривенное введение ингибиторов протонного насоса [35,36].…”

“…Комментарии: Остановке язвенных кровотечений и снижению риска развития повторных кровотечений способствует применение ИПН [35]. При этом одномоментно болюсно внутривенно вводится 80 мг эзомепразола** с последующей непрерывной внутривенной инфузией этого препарата (в дозе 8 мг в час) в течение 72 часов [36].…”

Octreotide for Gastrointestinal Hemorrhage from Esophageal Varices

“…One additional systematic review and network meta‐analysis, published in 2016, compared somatostatin to placebo, proton pump inhibitors, and histamine H2 receptor antagonists in patients with upper gastrointestinal hemorrhage (not limited to variceal bleeding). The authors included 47 randomized trials (n = 9528), reporting no significant all‐cause mortality benefit or the risk of rebleeding, similar to the Cochrane review. Somatostatin was not superior to other pharmacologic agents.…”

Systematic review with meta‐analysis: the efficacy of tranexamic acid in upper gastrointestinal bleeding

“…The role of tranexamic acid in upper gastrointestinal bleeding has been controversial 3,10 . A meta‐analysis published in 2014 found that tranexamic acid may have a beneficial effect on mortality, but the authors called for additional research on the topic due to some methodological weaknesses of the primary studies 11 .…”