Cochrane Review Selected

GI/GU

COCHRANE SYSTEMATIC REVIEW: Drugs for the treatment of nausea and vomiting in adults in the emergency department setting Implications for practice: Consider whether they need medicine or if fluid may be enough Review Overview: The evidence is current to August 2014. We included eight clinical trials of 952 participants. The trials assessed many different medicines at different doses, but only three trials included a placebo group (dummy medication). Six of these trials were of high quality, with low risk of error (i.e. bias, where the true effect is exaggerated). For this review, we included the effects of the medicines on nausea and vomiting up to one hour after the medicine was given. Key results and quality of the evidence The main results of interest were the effect on nausea between zero and 60 minutes after the medicine was given, number of vomits and side effects to medicines. Of these, only nausea at 30 minutes and side effects were reported by all trials. From all trials, only one medicine was reported to be better than placebo and other medicines. That was droperidol, which was included in one small trial of 97 participants. No other single medicine was definitely better than any other medicine, and none of the other trials that included a placebo group showed that the active medicines definitely worked better than the placebo. Side effects were mild. Our results suggest that in people in the emergency department, nausea will generally improve, whether they are treated with specific medicines or placebo. Therefore, supportive treatment, such as intravenous fluids (where fluid is given directly into a blood vessel) may be sufficient for many people. Overall, the quality of the evidence was low, mainly because there was not enough data. LINK to Cochrane Library: Issue 9, 2015 http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD010106.pub2/abstract
COCHRANE SYSTEMATIC REVIEW: Antiemetics for reducing vomiting related to acute gastroenteritis in children and adolescents Implications for practice: Ondansetron is an effective antiemetic Review Overview: Oral Ondansetron increased the proportion of patients who had ceased vomiting and reduced the number needing intravenous rehydration and immediate hospital admission. Intravenous Ondansetaron, and metoclopramide reduced the number of episodes of vomiting and hospital admission and dimenhydyrinate s a suppository reduced the duration of vomiting. LINK to Cochrane Library: Issue 9, 2011 http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD005506.pub5/pdf/abstract
COCHRANE SYSTEMATIC REVIEW: Antacids for preventing oesophagogastric variceal bleeding and rebleeding in Implications for practice: Effectiveness unknown Review Overview: Antacids are often used for emergency treatment of bleeding oesophageal varices in patients with cirrhosis of the liver. No randomized trials with antacids for preventing oesophagogastric variceal bleeding and bleeding in cirrhotic patients could be found. LINK to Cochrane Library: Issue 2 2008 http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD005443/frame.html
COCHRANE SYSTEMATIC REVIEW: Tranexamic acid for upper gastrointestinal bleeding Implications for practice: To assess the effects of tranexamic acid versus no intervention, placebo or other antiulcer drugs for upper gastrointestinal bleeding. Review Overview: These trials found that tranexamic acid appears to have a beneficial effect on mortality, but a high dropout rate in some trials means that we cannot be sure of these findings until additional research is published . Tranexamic acid did not reduce mortality in the trials that included antiulcer drugs or endoscopic therapy. Additional randomised controlled trials are needed before we can determine whether tranexamic acid has a beneficial effect on serious or uncontrolled upper gastrointestinal bleeding. LINK to Cochrane Library: Issue 11, 2014 http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD006640.pub3/abstract

COCHRANE SYSTEMATIC REVIEW: Drugs for the treatment of nausea and vomiting in adults in the emergency department setting
Implications for practice: Consider whether they need medicine or if fluid may be enough
Review Overview: The evidence is current to August 2014. We included eight clinical trials of 952 participants. The trials assessed many different medicines at different doses, but only three trials included a placebo group (dummy medication). Six of these trials were of high quality, with low risk of error (i.e. bias, where the true effect is exaggerated). For this review, we included the effects of the medicines on nausea and vomiting up to one hour after the medicine was given. Key results and quality of the evidence The main results of interest were the effect on nausea between zero and 60 minutes after the medicine was given, number of vomits and side effects to medicines. Of these, only nausea at 30 minutes and side effects were reported by all trials. From all trials, only one medicine was reported to be better than placebo and other medicines. That was droperidol, which was included in one small trial of 97 participants. No other single medicine was definitely better than any other medicine, and none of the other trials that included a placebo group showed that the active medicines definitely worked better than the placebo. Side effects were mild. Our results suggest that in people in the emergency department, nausea will generally improve, whether they are treated with specific medicines or placebo. Therefore, supportive treatment, such as intravenous fluids (where fluid is given directly into a blood vessel) may be sufficient for many people. Overall, the quality of the evidence was low, mainly because there was not enough data.
LINK to Cochrane Library: Issue 9, 2015 http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD010106.pub2/abstract

COCHRANE SYSTEMATIC REVIEW: Antiemetics for reducing vomiting related to acute gastroenteritis in children and adolescents
Implications for practice: Ondansetron is an effective antiemetic
Review Overview: Oral Ondansetron increased the proportion of patients who had ceased vomiting and reduced the number needing intravenous rehydration and immediate hospital admission. Intravenous Ondansetaron, and metoclopramide reduced the number of episodes of vomiting and hospital admission and dimenhydyrinate s a suppository reduced the duration of vomiting.
LINK to Cochrane Library: Issue 9, 2011 http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD005506.pub5/pdf/abstract

COCHRANE SYSTEMATIC REVIEW: Antacids for preventing oesophagogastric variceal bleeding and rebleeding in
Implications for practice: Effectiveness unknown
Review Overview: Antacids are often used for emergency treatment of bleeding oesophageal varices in patients with cirrhosis of the liver. No randomized trials with antacids for preventing oesophagogastric variceal bleeding and bleeding in cirrhotic patients could be found.
LINK to Cochrane Library: Issue 2 2008 http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD005443/frame.html

COCHRANE SYSTEMATIC REVIEW: Tranexamic acid for upper gastrointestinal bleeding
Implications for practice: To assess the effects of tranexamic acid versus no intervention, placebo or other antiulcer drugs for upper gastrointestinal bleeding.
Review Overview: These trials found that tranexamic acid appears to have a beneficial effect on mortality, but a high dropout rate in some trials means that we cannot be sure of these findings until additional research is published . Tranexamic acid did not reduce mortality in the trials that included antiulcer drugs or endoscopic therapy. Additional randomised controlled trials are needed before we can determine whether tranexamic acid has a beneficial effect on serious or uncontrolled upper gastrointestinal bleeding.
LINK to Cochrane Library: Issue 11, 2014 http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD006640.pub3/abstract