Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Shanghai, China.
Studies evaluating the effect of erythromycin on patients with acute upper gastrointestinal bleeding (UGIB) had been reported, but the results were inconclusive.
To compare erythromycin with control in patients with acute UGIB by performing a meta-analysis.
Electronic databases including PubMed, EMBASE and the Cochrane Library, Science Citation Index, were searched to find relevant randomised controlled trials (RCTs). Two reviewers independently identified relevant trials evaluating the effect of erythromycin on patients with acute UGIB. Outcome measures were the incidence of empty stomach, need for second endoscopy, blood transfusion, length of hospital stay, endoscopic procedure time and mortality.
Four RCTs including 335 patients were identified. Meta-analysis demonstrated the incidence of empty stomach was significantly increased in patients receiving erythromycin (active group 69%, control group 37%, P<0.00001). The need for second endoscopy, amount of blood transfusion and the length of hospital stay were also significantly reduced (all P<0.05). A trend for shorter endoscopic procedure time and decreased mortality rate was observed.
Prophylactic erythromycin is useful for patients with upper gastrointestinal bleeding to decrease the amount of blood in the stomach and reduce the need for second endoscopy, amount of blood transfusion. It may shorten the length of hospital stay, but its effects on mortality need further larger trials to be confirmed.
4. From Joint Peds/EM conference: This is just a reiteration of an excellent point made during the discussion: for healthy, self-limited new onset seizure in peds patient, NO emergency neuro-imaging needed unless: focal neuro deficit, prolonged altered state, fever, or focal seizure. If the kid needs an emergent neuro-imaging study due to one of these reasons, MRI far preferable. All kids will get EEG, try to arrange within 24 hours for improved predictive value, and EEG results will guide need for outpatient MRI.