Prevention of GI bleeding by prophylactic cimetidine administration in chronic liver failure

The possibility that prophylactic administration of cimetidine may reduce gastro-intestinal bleeding was examined in 162 patients with liver cirrhosis (LC), by comparing 135 patients observed without cimetidine prophylaxis to 27 with prophylaxis. Twenty-one out of these 27 had a period during which cimetidine was given and a period immediately preceding it when it was not given. The frequency of bleeding while on and off cimetidine was compared in these patients. Included among the 162 patients were 15 with the hepatorenal syndrome (HRS), 9 untreated and 6 treated with cimetidine. There were significantly more GI bleeding episodes in untreated patients, whereas only one mild haemorrhage was recorded in the group using prophylaxis (p <.01). The statistical significance was present even in the subgroups, including the 21 paired observations (p <.05) and the subjects with HRS. All 9 untreated patients with the HRS had bleeding, while none of the 6 who were treated had bleeding (p <.01). Thus, prophylaxis of GI haemorrhage by cimetidine administration in patients with LC appears to represent an effective form of prevention. The lack of undesiderable significant clinical effects in our study suggests that the cost-benefit ratio is acceptable.