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Acute pancreatitis and the role of histamine-2 receptor antagonists: a meta-analysis of randomized controlled trials of cimetidine

Morimoto, Takeshi; Noguchi, Yoshinori; Sakai, Tatsuya; Shimbo, Takuro; Fukui, Tsuguya

European Journal of Gastroenterology & Hepatology: June 2002 - Volume 14 - Issue 6 - pp 679-686
Original Articles: Pancreas

Objectives : Acute pancreatitis is a common disorder. Histamine type-2 receptor antagonists (H2RAs) are frequently used in patients with acute pancreatitis to reduce pancreatic juice secretion. However, most of the studies on this topic have involved only a few patients, demonstrating no beneficial effect but without harm. To clarify this matter, a meta-analysis was conducted to assess the efficacy of H2RAs.

Methods : All randomized controlled trials written in English comparing the effects of H2RAs with those of placebo were retrieved. Clinical outcome data were extracted and the results pooled to yield odds ratios or weighted mean differences. Two investigators reviewed articles independently and reached a consensus.

Results : A total of 285 patients from five studies were included. Cimetidine was the only H2RA used to treat acute pancreatitis. The pooled odds ratio of complications for H2RAs versus placebo was 1.64 (95% confidence interval [CI] 0.92 to 2.92). A weighted mean difference of duration of pain was 6.96 h (95% CI −2.50 to 16.43 h) in favour of placebo.

Conclusions : Cimetidine is not more effective than placebo in reducing acute pancreatitis-related complications and the duration of pain; rather, the use of cimetidine for acute pancreatitis could be associated with higher rates of complications and pain. Until the results of a large randomized trial show otherwise, H2RAs should not be used in the absence of specific clinical indications.

Department of General Medicine and Clinical Epidemiology, Kyoto University Graduate School of Medicine, Japan

Correspondence to Professor Tsuguya Fukui, MD, MPH, Department of General Medicine and Clinical Epidemiology, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan Tel: +81 75 751 4210; fax: +81 75 751 4211; e-mail: fkts@kuhp.kyoto-u.ac.jp

Takeshi Morimoto and this study were supported by St Luke's Life Science Institute, Tokyo, Japan.

Received 18 August 2001

Revised 2 October 2001

Accepted 23 January 2002

© 2002 Lippincott Williams & Wilkins, Inc.