Ranitidine versus ranitidine plus octreotide in the treatment of acute non-variceal upper gastrointestinal bleeding: A prospective randomised study

Aim: To compare the efficacy of ranitidine with that of ranitidine plus oct reotide in the treatment of non-variceal upper gastrointestinal (UGI) bleed ing. Design: Prospective, randomised, open study. Patients and Methods: Upper GI endoscopy was carried out during the first 2 4 hours in all patients with UGI bleeding who had been admitted within a pe riod of 18 months. Patients with variceal bleeding, and those who had under gone any type of gastric operation, were excluded. Eighty-four patients (58 men and 26 women) aged 21-92 years (mean age: 61.2 +/- 15.0 SD) were inclu ded. Patients were randomised to receive ranitidine SO mg tid intravenously alone (Group A: 44 patients, 29 men), or in combination with octreotide 10 0 mug tid subcutaneously, the second drug given for three days only (Group B: 40 patients, 29 men). The study end-points were discharge without operat ion, emergency surgical intervention or death. The number of blood units gi ven and the days of hospitalisation were also recorded. Results: Aspirin and non-aspirin NSAID use before bleeding was reported by 16/44 (36%) patients in Group A and by 19/40 (47.5%) patients in Group B (p = 0.38, OR = 0.63, 95% CI = 0.26-1.51). The endoscopically detected pathol ogy and bleeding stigmata did not differ between the groups (p = 0.86, p = 0.64, OR = 0.78, 95% CI = 0.3-1.99, respectively). Mean use of blood units (p = 0.16) and days of hospitalisation (p = 0.25) did not differ. Three pat ients in Group A (6.8%) and three in Group B (7.5%) required surgical inter vention (p = 1.0, OR = 1.1, 95% CI = 0.21-5.84). Conclusion: Ranitidine plus subcutaneous octreotide is not superior to rani tidine alone in the management of patients with acute non-variceal UGI blee ding.