Evidence
This page contains a snapshot of featured content which highlights evidence addressing key clinical questions including areas of uncertainty. Please see the main topic reference list for details of all sources underpinning this topic.
BMJ Best Practice evidence tables
Evidence tables provide easily navigated layers of evidence in the context of specific clinical questions, using GRADE and a BMJ Best Practice Effectiveness rating. Follow the links at the bottom of the table, which go to the related evidence score in the main topic text, providing additional context for the clinical question. Find out more about our evidence tables.
This table is a summary of the analysis reported in a Cochrane Clinical Answer that focuses on the above important clinical question.
Confidence in the evidence is very low or low where GRADE has been performed and there may be no difference in effectiveness between the intervention and comparison for key outcomes. However, this is uncertain and new evidence could change this in the future.
Population: Adults with acute upper gastrointestinal haemorrhage
Intervention: Erythromycin ᵃ
Comparison: Placebo ᵃ
| Outcome | Effectiveness (BMJ rating)? | Confidence in evidence (GRADE)? |
|---|---|---|
All‐cause mortality (follow‐up: 1 week) | No statistically significant difference | Very Low |
Upper gastrointestinal haemorrhage (UGIH)‐related mortality (Follow‐up: 1 week) | See note ᵇ | Very Low |
Serious adverse events (follow‐up: 1 week) | No statistically significant difference | Very Low |
Non‐serious adverse events (follow‐up: 1 week) | No statistically significant difference | Very Low |
Rebleeding (follow‐up: 1 day) | No statistically significant difference | Very Low |
Rescue invasive intervention (follow‐up: not reported) | No statistically significant difference | GRADE assessment not performed for this outcome |
Blood transfusion (follow‐up: 1 day) | Favours intervention ᶜ | Low |
Visualisation of gastric mucosa (follow‐up: not reported) | Favours intervention | Low |
Health‐related quality of life | - | None of the studies identified by the review assessed this outcome |
Note ᵃ Please see the Cochrane Clinical Answer (CCA) for details of other comparison groups (erythromycin alone compared with nasogastric tube lavage and erythromycin combined with nasogastric tube lavage versus placebo/no treatment plus nasogastric tube lavage). ᵇ Three RCTs (255 participants) reported no UGIH-related deaths in either treatment group. ᶜ The CCA noted that erythromycin compared with placebo may result in a slight decrease in blood transfusion requirements (approximately two‐fifths of a unit less).
This evidence table is related to the following section/s:
This table is a summary of the analysis reported in a Cochrane Clinical Answer that focuses on the above important clinical question.
Confidence in the evidence is very low or low where GRADE has been performed and there may be no difference in effectiveness between the intervention and comparison for key outcomes. However, this is uncertain and new evidence could change this in the future.
Population: Adults with clinical signs of upper gastrointestinal bleeding prior to endoscopic diagnosis
Intervention: PPIs
Comparison: Control (H₂ antagonist, placebo, or no treatment)
| Outcome | Effectiveness (BMJ rating)? | Confidence in evidence (GRADE)? |
|---|---|---|
Mortality within 30 days | No statistically significant difference | Low |
Rebleeding within 30 days | No statistically significant difference | Low |
Surgery within 30 days | No statistically significant difference | Low |
Participants requiring blood transfusion | No statistically significant difference | Very Low |
Proportion of participants with stigmata of recent haemorrhage at index endoscopy within 30 days | No statistically significant difference | Low |
Endoscopic haemostatic treatment at index endoscopy | Favours intervention | Moderate |
Adverse effects | See note ᵃ | GRADE assessment not performed for this outcome |
Note The Cochrane review which underpins this Cochrane Clinical Answer (CCA) noted that the clinically important outcomes of mortality and rebleeding should drive clinical decisions and guideline recommendations. Since the results for these outcomes in this review remain inconclusive, it is not possible to form any clear conclusions about practice based on them. As the benefit of starting PPIs before endoscopy is limited to the reduction in need for endoscopic haemostatic treatment at index endoscopy, the Cochrane review notes that certain factors (e.g., delayed endoscopy or if expertise in endoscopic haemostasis is suboptimal) will influence the decision as to whether PPI treatment prior to endoscopy is warranted. The Cochrane review noted that the balance between benefits and harms, patient values and preferences, resource requirement, cost‐effectiveness, feasibility, acceptability, and equity implications, all of which are beyond the scope of this systematic review, also need to be considered. ᵃ Results reported narratively. Five RCTs (2352 participants) reported adverse events. Adverse events reported included fatigue, diarrhoea, vertigo, nausea, and constipation. In general, there was little to no difference between groups.
This evidence table is related to the following section/s:
Cochrane Clinical Answers
Cochrane Clinical Answers (CCAs) provide a readable, digestible, clinically focused entry point to rigorous research from Cochrane systematic reviews. They are designed to be actionable and to inform decision making at the point of care and have been added to relevant sections of the main Best Practice text.
- For people with upper gastrointestinal bleeding, what are the effects of proton pump inhibitors (PPIs) prior to endoscopic diagnosis?
- What are the benefits and harms of erythromycin prior to endoscopy for people with acute upper gastrointestinal hemorrhage?
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