H2-RECEPTOR ANTAGONISTS AND ANTACIDS IN THE PREVENTION OF ACUTE GASTROINTESTINAL HÆMORRHAGE IN FULMINANT HEPATIC FAILURE: Two Controlled Trials

doi:10.1016/S0140-6736(77)92055-4

The Lancet

Volume 309, Issue 8012, 19 March 1977, Pages 617-619

https://doi.org/10.1016/S0140-6736(77)92055-4 Get rights and content

Abstract

In two controlled trials, involving 75 patients, on the prevention of bleeding from gastric erosions in fulminant hepatic failure, antacids given four-hourly had no significant effect. Only 35% of intragastric pH recordings taken at two-hourly intervals in the treated group were maintained above 5 with the doses used, whereas this could be consistently achieved with the histamine H₂-receptor antagonists, metiamide and cimetidine. In the group receiving these drugs only 1 patient out of 26 bled, compared with 13 (54%) of the controls, a highly significant difference. Blood-transfusion requirements were significantly less in those treated with H₂-receptor antagonists.

References (23)

H.O. Conn et al.
Gastroenterology
(1975)
K.J. Ivey
Med. Clins N. Am.
(1974)
W.P. Ritchie
Gastroenterology
(1975)
W.L. Burland et al.
Lancet
(1975)
J.R.H. Forrest et al.
Lancet
(1975)
S. Safaie-Shirazi et al.
Gastroenterology
(1976)
W. Silen et al.
Adv. intern. Med.
(1972)
R. Clark et al.
Scand. J. Gastroent.
(1973)
C. Trey et al.
Progress in Liver Disease
Silk, D. B. A....

C.E. Lucas et al.

Archs Surg.

(1971)

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H2-RECEPTOR ANTAGONISTS AND ANTACIDS IN THE PREVENTION OF ACUTE GASTROINTESTINAL HÆMORRHAGE IN FULMINANT HEPATIC FAILURE: Two Controlled Trials

Abstract

Gastroenterology

Med. Clins N. Am.

Gastroenterology

Lancet

Lancet

Gastroenterology

Adv. intern. Med.

Scand. J. Gastroent.

Progress in Liver Disease

Archs Surg.

H₂-RECEPTOR ANTAGONISTS AND ANTACIDS IN THE PREVENTION OF ACUTE GASTROINTESTINAL HÆMORRHAGE IN FULMINANT HEPATIC FAILURE: Two Controlled Trials