Upper GI bleed: : non-variceal: somatostatin or octreotide reduces rebleeding and the need for surgery.

Clinical bottom line (level 1a)

  1. Patients with non-variceal upper GI bleeding who receive somatostatin or octreotide compared with H 2 antagonists or placebo are less likely to continue bleeding or rebleed (NNT = 6 at unknown) , or require surgery (NNT = 12 at unknown)
Imperiale and Birgisson: Annals of Internal Medicine 1997; 127: 1062-1071
Expires October 2002

The study

Systematic review of randomised clinical trials of
  • Patients: acute non-variceal upper GI bleed confirmed on endoscopy
  • Intervention: somatostatin 250 micrograms/hour (+/- bolus) or octreotide for 2 to 5 days compared with H 2 antagonists (ranitidine or cimetidine) or placebo
  • Outcome: continuous or persistent bleeding, recurrent bleeding, need for surgery, transfusion requirements


Articles found in English using MEDline and EMBASE, 1966 to 1996 (search terms: 'somatostatin', 'octreotide' and 'gastrointestinal haemorrhage' ) and and references from retrieved articles, review and gastroenterology textbooks.

Selection criteria: see above
Appraisal criteria: detailed in text by blinded investigators
Articles excluded if:
  • articles focussing on other research question
  • review articles, editorials or letters


14 studies found involving 1829 patients
  • Patients were typically excluded from the selected studies if they had bleeding due to portal hypertension or cancer, presence of coagulopathy, renal insufficiency, pregnancy or trivial or massive bleeding.
Studies were found to be heterogeneous for all three outcomes.

The evidence

Outcome Time to outcome CER RR
(95% CI)		 NNT
(95% CI)
continued bleeding or rebleeding unknown /
(38%)		 0.53
(0.43 to 0.63) 		6
(5 to 7)
continued bleeding unknown /
(36%)		 0.44
(0.33 to 0.55) 		5
(4 to 6)
surgery weeks /
(28%)		 0.71
(0.61 to 0.81) 		12
(9 to 19)

Comments

  1. Note; the conclusion is based on a subgroup analysis of all patients with nonvariceal bleeding.
  2. By limiting the search only to English language articles, important studies may have been missed.

    Citation

    1. Imperiale TF, and Birgisson S: Somatostatin or octreotide compared with H2 antagonists and placebo in the management of acute non-variceal upper gastrointestinal haemorrhage: a meta-analysis. Annals of Internal Medicine 1997; 127: 1062-1071
    Contributor: Chris Ball and Musab Hayatli, October 1999
    Reviewer: Lawrence Friedman

    Clinical Question.
    Patient acute non-variceal GI bleed
    Intervention or Exposure somatostatin or octreotide
    Comparison H2 antagonists or placebo
    Outcome continuous bleeding, rebleeding, surgery