Cimetidine and Acute Upper Gastrointestinal Bleeding: A Double‐blind Controlled Trial

Abstract

Patients presenting with acute upper gastrointestinal bleeding from a variety of lesions were admitted to a prospective double-blind controlled trial to determine if cimetidine reduces the severity of bleeding and/or the incidence of rebleeding. During the first 48 hours, the patients received intravenous cimetidine (200 mg four-hourly) or placebo, and for the following ten days, oral cimetidine (1 g/24 hr) or placebo. Eight-eight patients entered the trial of whom 45 (51%) were in the cimetidine-treated group. Six of the seven patients requiring surgery for life-threatening bleeding and four of the six patients who rebled were in the cimetidine-treated group. This study failed to demonstrate any advantage of using cimetidine routinely in the treatment of acute upper gastrointestinal bleeding.

Upper gastrointestinal bleeding: the trials of trials.

“…In only one of 12 such trials where the value of treatment has been compared with that of placebo, were there more than five deaths recorded in placebo treated patients (even then a number far too small to permit reliable comparisons with the treated groups.) [1][2][3][4][5][6][7][8][9][10][11][12] Assessment is complicated by at least three other problems. Where sets of data do not show overall differences of substance there is an understandable but dangerous and misleading tendency to carry out subgroup analyses.…”