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 16 January 2018

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News

Control of acid secretion improves outcome after ulcer bleeding

A meta-analysis in the September issue of Alimentary Pharmacology and Therapeutics by Dr N Selby and colleagues from Nottingham, UK, concludes that acid lowering drugs decrease re-bleeding and surgery in patients with peptic ulcer hemorrhage.

News image

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There was no effect in using these medications upon mortality.

The study noted that only 38% of doctors continue to use acid decreasing therapies in the acute management of these patients.

Controlling acid secretion lowers re-bleeding and surgery rates.

The perceived failure of these drugs in the past may reflect inadequate pH control on an acid-labile thrombus. Therefore, it was argued that more powerful drugs might be more effective.

21 randomized controlled trials were analyzed, identified from the Medline database between 1980 and 1999. Selected studies had to use a placebo control, to use no additional therapies and must not have excluded a large number of patients. The total number of patients was 3566.

A significant decrease in the need for surgery (OR 0.75), but not re-bleeding rate or mortality, was noted with the use of H2-antagonists.

Proton pump inhibitors were more effective, with a larger decrease in the re-bleeding rate (OR 0.52) as well as a lesser need for surgery (OR 0.58). Again, mortality was unaffected.

There were no significant adverse effects noted with the administration of these drugs.

Dr Selby concludes, "Acid lowering medications do decrease re-bleeding and surgery rates".

Aliment Pharmacol Ther 14 (9): 1119-26
05 September 2000

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