Somatostatin or Octreotide Compared with H2 Antagonists and Placebo in the Management of Acute Nonvariceal Upper Gastrointestinal Hemorrhage

Somatostatin or Octreotide Compared with H₂ Antagonists and Placebo in the Management of Acute Nonvariceal Upper Gastrointestinal Hemorrhage

A Meta-Analysis

Thomas F. Imperiale, MD; and
Sigurbjorn Birgisson, MD

From Roudebush Veterans Affairs and Indiana University Medical Centers, Indiana University, Indianapolis, Indiana; and Case Western Reserve University at MetroHealth Medical Center, Cleveland, Ohio. Acknowledgments: The authors thank Charles L. Thomas, BA, for assistance with SAS programming; Anne Conrad for preparation of figures; Michael J. McFarlane, MD, and Jaya Rao, MD, for manuscript review; and Linda Gall and Melissa Schmitt for manuscript preparation. Grant Support: By the Departments of Medicine of MetroHealth Medical Center, Indiana University Medical Center, and Roudebush Veterans Affairs Medical Center. Requests for Reprints: Thomas F. Imperiale, MD, Indiana University Medical Center, 975 West Walnut Street, IB 424, Indianapolis, IN 46202-5121. Current Author Addresses: Dr. Imperiale: Indiana University Medical Center, 975 West Walnut Street, IB 424, Indianapolis, IN 46202-5121.

Abstract

Purpose: To determine the efficacy of somatostatin or octreotide for the treatment of acute nonvariceal upper gastrointestinal hemorrhage.

Data Sources: Database searches of English-language articles published between 1966 and 1996 and the bibliographies of all related articles and textbook chapters.

Study Selection: Randomized clinical trials comparing somatostatin or octreotide with H₂ blockers or placebo in patients with a clinical or endoscopic diagnosis of acute nonvariceal upper gastrointestinal hemorrhage.

Data Extraction: Methods and quality of the studies were evaluated, and quantitative data on outcomes, including continued bleeding, rebleeding during the treatment period, need for surgery, and transfusion requirement, were extracted.

Data Synthesis: Among 1829 patients from 14 trials, the relative risk (RR) for continued bleeding or rebleeding was 0.53 (95% CI, 0.43 to 0.63) in favor of somatostatin, with a number needed to treat (NNT) of 5. Among 7 investigator-blinded trials, the relative risk was 0.73 (CI, 0.64 to 0.81) and the NNT was 11. Somatostatin was efficacious for peptic ulcer bleeding (RR, 0.48 [CI, 0.39 to 0.59]; NNT, 4) and showed a trend toward efficacy for non-peptic ulcer bleeding (RR, 0.62 [CI, 0.39 to 1.002]). Although the overall results suggested a decreased need for surgery in the somatostatin group, a subgroup analysis of investigator-blinded trials revealed a more modest effect that was not statistically significant (RR, 0.94 [CI, 0.87 to 1.001]).

Conclusion: Somatostatin may reduce the risk for continued bleeding from acutely bleeding peptic ulcer disease. Somatostatin may be useful either as an adjunct treatment before endoscopy or when endoscopy is unsuccessful, contraindicated, or unavailable.