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Meta‐analysis: the efficacy of intravenous H 2 ‐receptor antagonists in bleeding peptic ulcer
Author(s) -
Levine J. E.,
Leontiadis G. I.,
Sharma V. K.,
Howden C. W.
Publication year - 2002
Publication title -
alimentary pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.308
H-Index - 177
eISSN - 1365-2036
pISSN - 0269-2813
DOI - 10.1046/j.1365-2036.2002.01274.x
Subject(s) - medicine , odds ratio , gastroenterology , placebo , randomized controlled trial , histamine h2 receptor , surgery , receptor , antagonist , pathology , alternative medicine
Summary Background : Although a previous meta‐analysis found that intravenous H 2 ‐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. Aim : To re‐evaluate the efficacy of intravenous H 2 ‐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 H 2 ‐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 H 2 ‐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 H 2 ‐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 H 2 ‐receptor antagonists, they may be more effective in ulcer bleeding and should be further evaluated for that indication.