Clinical Benefits of Intravenously Administered Famotidine in the Treatment of Upper Gastrointestinal Hemorrhage Caused by Peptic Ulcer and Stress Ulcer Disease

Abstract

Bleeding may stop spontaneously in mild or moderate cases of GI bleeding. Therefore, to prove that H2-receptor antagonists effectively stop GI bleeding, evaluation of the results of treatment in patients who are classified as severe cases by the Nagao taxonomy is needed. Data from the literature show that mortality is higher in patients with specific endoscopic findings, such as active bleeding, visible vessels, clot, or stain, than it is in patients without these findings. The criteria for establishing whether H2-receptor antagonists effectively control GI bleeding in severe cases include a reduction in mortality, in the rate of recurrent bleeding, or in the rate of emergency surgery. Data gathered from a current multicenter trial assessing the efficacy of 20 mg famotidine administered intravenously twice daily show that the rate of emergency surgery in patients with bleeding ulcer is 8.6%, which is substantially less than the 54.2% rate found in a retrospective review of patients treated before the introduction of H2-receptor antagonists. In addition, there were no deaths among famotidine-treated patients. Similarly, among patients with bleeding caused by stress ulcer, the percentage who were treated with famotidine and required emergency surgery was much less than that in the historical control group (15.8% versus 40.0%). Famotidine was effective in greater than or equal to 88% of patients with peptic ulcers and in 78.9% of patients with stress ulcers. Recurrent bleeding occurred more often in patients with exposed blood vessels. Intravenously administered famotidine is, therefore, effective for the control of GI bleeding caused by severe peptic ulcer and stress ulcer disease.