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Erythromycin infusion fosters upper gastrointestinal preparation for endoscopy

Reuters Health • The Doctor's Channel Daily Newscast

NEW YORK (Reuters Health) – Erythromycin infusion fosters preparation of the upper gastrointestinal tract for endoscopy in patients with upper gastrointestinal bleeding without the need for nasogastric tube placement and gastric lavage, researchers from France report in the February 17th online issue of Annals of Emergency Medicine.

Nasogastric tube placement is uncomfortable, even painful, for the patient, time consuming, and rarely met with complications, but it is commonly placed in the setting of upper gastrointestinal bleeding.

Erythromycin accelerates gastric emptying by inducing antral contractions, and it has been shown to be more effective than placebo in cleaning the gastrointestinal tract before endoscopy.

This study by Dr. Dominique Pateron from Pierre et Marie Curie-Paris 6 University, Paris, France and colleagues is the first head-to-head comparison of intravenous erythromycin versus gastric lavage to investigate the frequency of satisfactory stomach visualization in patients with acute upper gastrointestinal bleeding presenting with hematemesis or melena.

Of 253 patients enrolled, 84 were randomized to erythromycin infusion, 85 to gastric lavage via nasogastric tube, and 84 to erythromycin plus gastric lavage.

The mean endoscopic score did not differ among the 3 groups, and there was satisfactory stomach visualization in 84% of patients in the erythromycin group, 82% of patients in the gastric lavage group, and 88% of patients in the erythromycin-gastric lavage group.

Any potential difference in satisfactory stomach visualization between the erythromycin and gastric lavage groups is unlikely to exceed 9%, given the confidence intervals, the researchers note, adding “This clinically acceptable difference is much smaller than the 15% difference we used to calculate sample size.”

Secondary endpoints were also similar for all 3 groups, except that the percentage of transfused patients with satisfactory stomach visualization was significantly lower in the gastric lavage group than in the erythromycin-gastric lavage group.

Severe pain was reported by 28% of patients in the gastric lavage group and 24% of patients in the erythromycin-gastric lavage group (P=0.59).

“In our study, nasogastric tube placement and gastric lavage did not influence outcomes even in the most severely ill patients,” the authors conclude. “One can therefore conclude that erythromycin infusion might be a good substitute for gastric lavage, avoiding nasogastric tube placement before endoscopy, in emergency department patients with acute upper gastrointestinal bleeding presenting with hematemesis or melena.”

Annals of Emergency Medicine 17 February 2011.