Erythromycin in Acute Upper Gastrointestinal Bleeding: A Meta-Analysis of Randomized Controlled Trials

Abstract

Purpose: Emergent upper endoscopy is the standard of care in patients with upper gastrointestinal bleeding (UGIB). Adequate visualization of the upper gastrointestinal tract is important for diagnosis and therapy. Several studies have evaluated the role of erythromycin before endoscopy with mixed results. We performed a meta-analysis of randomized controlled trials (RCTs) to assess the efficacy of erythromycin for acute UGIB prior to endoscopy. Methods: MEDLINE, Cochrane Central Register of Controlled Trials & Database of Systematic Reviews, PubMed, and recent abstracts from major conference proceedings were searched (through 6/12). RCTs evaluating the role of erythromycin in acute UGIB in adult patients were included. Standard forms were used to extract data by two independent reviewers. Data regarding the following outcomes were extracted: visualization of the mucosa, need for repeat endoscopy, blood transfusion and the length of stay. Summary statistics was computed using Comprehensive Meta-analysis software. Publication bias was assessed by funnel plots. All studies were graded by Jadad score. Heterogeneity among studies was assessed. Results: Seven studies met the inclusion criteria (n=657). Patients with both variceal and non-variceal bleeding were included in the studies. Mean age ranged from 56-64.5 years. Dose of erythromycin that was administered varied from 125 mg to 3 mg/kg. Endoscopy was performed 20-120 mins after administration of erythromycin. Mucosal visualization was improved with erythromycin (RR 1.6; 95% CI 1.14-2.35, p=0.008). The NNT was 4 (95% CI, 2-11). Erythromycin decreased the need for repeat endoscopy (RR 0.52, 95% CI 0.31-0.89, p=0.02, I2=18, NNT 11). The need for blood transfusion were lower with erythromycin (WMD -0.52; 95% CI -0.957 to 0.08), p=0.02). Length of hospital stay was shorter (mean difference: 1.56, 95% CI 0.6-2.5). Conclusion: Erythromycin prior to endoscopy in adult patients with upper GI bleed improves visualization of the mucosa and decreases the need for repeat endoscopy. Hospital stay was shorter and need for blood transfusion was less with erythromycin.