Upper gastrointestinal haemorrhage: Erythromycin may improve gastric mucosal visualization and reduce transfusion requirements

Cochrane Pre-hospital and Emergency Care

Upper gastrointestinal haemorrhage: Erythromycin may improve gastric mucosal visualization and reduce transfusion requirements

SOURCE

Adão, D., Gois, A. F., Pacheco, R. L., Pimentel, C. F., & Riera, R. (2023).

Erythromycin prior to endoscopy for acute upper gastrointestinal haemorrhage.

Cochrane Database of Syst Rev 2, CD013176.

CONTEXT

Upper gastrointestinal haemorrhages (UGIH) are associated with significant morbidity and mortality. Upper gastrointestinal endoscopy allows identification of the underlying cause and remains the preferred approach for delivering definitive treatment. Erythromycin promotes gastric emptying within 15 to 30 minutes following intravenous administration. However, its potential role in improving the quality and therapeutic effectiveness of upper gastrointestinal endoscopy remains uncertain.

CLINICAL QUESTION

Are there benefits and/or risks associated with the use of erythromycin prior to endoscopy in adults presenting with UGIH?

BOTTOM LINE

Intravenous erythromycin has been compared to placebo. In this context, erythromycin may slightly improve visualisation of gastric mucosa and reduce blood transfusion requirements (moderate level of evidence). No differences have been observed in mortality or adverse events; however, the evidence is very uncertain (low level of evidence).

Nasogastric tube lavage, whether used alone or in combination with erythromycin, has not shown any significant difference in terms of visualisation of gastric mucosa, mortality, or blood transfusion, but the evidence remains very uncertain (low level of evidence).

CAVEATS 

The administration protocols for erythromycin varied significantly across the 11 included studies. This heterogeneity contributes to the inconsistency between studies, thereby lowering the overall certainty of evidence in the meta-analysis.

AUTHORS

1. J. Dumouchel

Urgences, F-37000 Tours, France

2. A. Renard

Bataillon de Marins-Pompiers de Marseille, F-13233, Marseille, France