Upper GI bleed: no clear benefit from cimetidine

Clinical bottom line (level 1b-)

Patients with upper GI bleeding who took cimetidine compared with placebo were not clearly less likely to have recurrent bleeding or require emergency surgery.

La Brooy et al: Gut 1979; 20: 892-895

Expires January 2003

The study

Double-blinded ?concealed randomised trial without intention-to-treat
Setting: acute hospitals, UK

101 patients (aged 20 to 87, 74% male) admitted to hospital with a history of haematemesis in the last 24 hours

Excluded if

aged < 16

pregnant

malignancy of upper GI tract

renal or hepatic failure

bleeding oesophageal varices

Note:

Patients were stratified for age (> 60) and severity of haemorrhage before randomisation.

Control Group: (n = , 50 analysed): placebo
Experimental Group: (n = , 51 analysed): cimetidine 800 mg orally immediately then 400 mg every 6 hours for 7 days
All patients had magnesium trisilicate 10 mg q2h orally.
94% followed for 7 days
Outcome notes:

continuing or recurrent haemorrhage : haematemesis or passage of liquid melena, marked drop in blood pressure, rise in pulse rate or a sudden drop in Hb

The evidence

Outcome	Time to outcome	CER	EER	RRR (95% CI)	ARR (95% CI)	NNT (95% CI)
continuing or recurrent haemorrhage	7 days	12 (24.0%)	11 (21.57%)	10% (-84% to 56%)	2.43% (-13.9% to 18.8%)	41 (NNT = 5 to infinity; NNH = 7 to infinity)
emergency surgery required	7 days	7 (14.0%)	6 (11.76%)	16% (-133% to 70%)	2.24% (-10.8% to 15.3%)	45 (NNT = 7 to infinity; NNH = 9 to infinity)

Comments

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

Citation

La Brooy SJ, Misiewicz JJ, Edwards J, et al: Controlled trial of cimetidine in upper gastrointestinal haemorrhage. Gut 1979; 20: 892-895

Contributor: Chris Ball and Musab Hayatli, Unknown Month 1999
Reviewer:

_{Clinical Question.}

_Patient	_{upper GI bleed}
_{Intervention or Exposure}	_cimetidine
_Comparison	_placebo
_Outcome	_{recurrent bleeding, emergency surgery}