Upper GI bleed: peptic ulcer: H. pylori eradication therapy reduced rebleeding.

Clinical bottom line (level 1b)

  1. Patients who bled from a peptic ulcer and had H. pylori infection who received triple therapy and ranitidine compared with ranitidine alone were less likely to rebleed (NNT = 4 at 10 months) .
Graham et al: Scand Journal of Gastroenterol 1993; 28: 939-942
Expires October 2002

The study

Unblinded ?concealed randomised trial without intention-to-treat
Setting: Veteran Affairs Hospital, USA

33 patients (aged 27 to 72, median 60, 100% male) with upper GI bleeding severe enough to require hospitalisation , endoscopically proven peptic ulcer disease and a positive test for H. pylori (by urea breath test, ELISA and histology) within 1 week of admission

Excluded if
  • negative H. pylori test for at least 4 months of follow-up

Control Group: (n = 14, 14 analysed): ranitidine 300 mg po daily
Experimental Group: (n = 17, 17 analysed): ranitidine 300 mg po daily plus triple therapy: tetracycline 250 mg po qds, metronidazole 250 mg po tds, and bismuth subsalicylate 5 to 8 tablets daily for 2 weeks.
On ulcer healing was confirmed on endoscopy, ranitidine was stopped.
100% followed for 10 months range 4 to 26 months
Outcome notes:
  • rebleeding : significant GI blood loss requiring hospitalisation with melena or hematemesis, or orthostatic vital signs or the need for blood transfusion.

The evidence

Outcome Time to outcome CEREERRRR
(95% CI)		ARR
(95% CI)		NNT
(95% CI)
rebleeding 10 months 4
(28.6%)		 0
(0.0%)		 100%
(% to %)		 28.6%
(4.91% to 52.2%)		 4
(2 to 20)

Comments

  1. This is a subgroup analysis of a larger study making these results less certain.
  2. Other studies (e.g. Labenz 1994) also support this conclusion.

Citation

  1. Graham DY, Hepps KS, Ramirez FC, et al: . Scand Journal of Gastroenterol 1993; 28: 939-942
Contributor: Chris Ball and Musab Hayatli, October 1999
Reviewer: Santiago Alvarez Montero

Clinical Question.
Patient upper GI bleed from peptic ulcer disease
Intervention or Exposure triple therapy and ranitidine
Comparison ranitidine
Outcome rebleeding