Upper GI bleed: eating immediately following endoscopy had no clear effect on rebleeding

Clinical bottom line (level 1b-)

  1. Patients with an upper GI bleed from an ulcer or a Mallory-Weiss tear who started eating immediately after endoscopy compared with delaying for 36 hours were not clearly more likely to rebleed.
Laine et al: Gastroenterology 1992; 102: 314-316
Expires October 2002

The study

Unblinded ?concealed randomised trial without intention-to-treat
Setting: university hospital, USA

285 patients (aged ?, ?% male) with an upper GI bleed and a non-bleeding Mallory-Weiss tear or an ulcer (with a clean base, a flat pigmented spot or an adherent clot) on endoscopy

Excluded if
  • heart rate < 110 beats/min
  • orthostatic changes in blood pressure <20 mmHg
  • fall in haematocrit <6% in 12 hours
  • transfused < 2 units of blood


Control Group: (n = 128, 124 analysed): delayed refeeding: nothing by mouth for 36 hours followed by a clear liquid diet for 12 hours, then a regular diet
Experimental Group: (n = 130, 127 analysed): immediate refeeding: regular diet immediately after endoscopy

97% followed for 3 days

The evidence

Outcome Time to outcome CEREERRRR
(95% CI)		ARR
(95% CI)		NNT
(95% CI)
rebleeding 3 days 5
(3.94%)		 6
(4.84%)		 -23%
(-292% to 62%)		 -0.90%
(-5.97% to 4.17%)		 -111
(NNT = 24 to infinity;
NNH = 17 to infinity)

Comments

  1. The study is too small to show any clear difference between the two groups.
 

    Citation

    1. Laine L, Cohen H, Brodhead J, et al: Prospective evaluation of immediate versus delayed refeeding and prognostic value of endoscopy in patients with upper gastrointestinal hemorrhage. Gastroenterology 1992; 102: 314-316
    Contributor: Chris Ball and Musab Hayatli, October 1999
    Reviewer:

    Clinical Question.
    Patient endoscopy
    Intervention or Exposure immediate feeding
    Comparison delayed feeding
    Outcome bleed, adverse effect