ORLANDO, FLA. — A combination of endoscopic and medical treatment of bleeding peptic ulcers with adherent clots results in a significantly lower rebleeding rate than does medical therapy alone, according to findings from a metaanalysis of randomized clinical trials.
Peptic ulcers with adherent clots are problematic because of highly variable rebleeding rates that range from 8% to 36%, Charles J. Kahi, M.D., said at the annual meeting of the American College of Gastroenterology.
In the metaanalysis, patients who received combination therapy had about a 60% lower risk of rebleeding than did those who received medical therapy alone.
During a search of four databases (Medline, Embase, Thomson Biosis, and Brown University Cochrane Center's Central) for trials published during 1966–2003, Dr. Kahi and his colleagues located six randomized trials that compared the combination of endoscopic and medical therapies with medical therapy alone for bleeding peptic ulcers with adherent clots. They contacted the primary authors of the studies, obtained the raw data from each of the trials, and combined all the data into one database.
Four studies were fully published reports, and two were published in abstract form. The six studies included a total of 240 patients.
Overall, three of the trials found no difference in rebleeding rates, whereas the remaining three trials found that the combination treatment gave a significantly lower rebleeding rate than did medical therapy alone, said Dr. Kahi of Indiana University, Indianapolis.
In the four fully published studies, rebleeding occurred in significantly fewer patients (8% [5 of 61 patients]) who received endoscopic plus medical therapy than in those who received medical therapy alone (25% [21 of 85 patients]).
The two groups did not differ in their length of hospital stay, number of transfusions, or mortality.
In each of the studies, endoscopic therapy consisted of clot removal and treatment of the underlying lesion with thermal energy, electrocoagulation, and/or injection of sclerosing agents. Medical therapy included supportive care, ICU monitoring, and acid suppressive medications, such as histamine-2 receptor antagonists or proton-pump inhibitors.
Dr. Kahi cautioned that the metaanalysis might include publication bias because reports of negative studies might not have been published. He also noted that the trials included patients from the United States, Hong Kong, Spain, and South Korea, who may have different responses to medical therapy because of genetic differences.