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Emerg Med J 23:873-874 doi:10.1136/emj.2006.042168
  • Best evidence topic reports

Use of lidocaine in the gastrointestinal cocktail for the treatment of dyspepsia

  1. Jason Bowman, Resident Physician,
  2. Jeffrey Jones, Staff Physician
  1. Grand Rapids Medical Education Research Center, Michigan, USA

      Report by Jason Bowman, Resident Physician.Search checked by Jeffrey Jones, Staff PhysicianGrand Rapids Medical Education Research Center, Michigan, USA

      Abstract

      A short-cut review was carried out to establish whether lidocaine is a useful adjuvant in the gastrointestinal cocktail of dyspepsia treatment. 325 citations were reviewed, of which two answered the three-part question. The clinical bottomline is that antacid alone should be used as preferred treatment for dyspesia. The addition of lidocaine and donnatal can be used on doctor’s discretion in patients without contraindications to these agents.

      Clinical scenario

      A 35-year-old man presents to the emergency department with a history of burning pain radiating from his epigastric area up through his mediastinum that started after dinner. The patient had a history of gastro-oesophageal reflux disease and was placed on prilosec treatment last year, but has stopped taking this for 3 months. You decide to treat this probable case of dyspepsia with a gastrointestinal cocktail, a mixture of lidocaine and antacid, but wonder if adding the lidocaine yields any benefit.

      Three-part question

      In [patients with dyspepsia who present to the emergency department] is the [GI Cocktail better than Antacid alone] in [relieving pain].

      Search strategy

      Medline 1966 to June 2006 using OVID interface. [exp Antacids/or exp Lidocaine/or gi cocktail.mp or exp Anesthetics, Local/] AND [dyspepsia.mp or exp Dyspepsia/]

      Search outcome

      Altogether 325 papers were found, of which two were relevant to the three-part question.

      Comments

      The papers above give different opinions on the most effective treatment of dyspepsia in the emergency department. Both treatments have been used for years in the emergency department for treating dyspepsia. The addition of lidocaine and sometimes donnatal to make the gastrointestinal cocktail in theory could possibly increase the efficacy of the treatment with the addition of the local anaesthesia and anti-spasmodic agent. The risk of these additions is low with both agents being very well tolerated, and the additional cost of adding these agents is minimal as well. However, with any drug addition there is some added risk and cost. which. with the frequency that the gastrointestinal cocktail is used, could add up substantially. The findings in Watson’s study of no clinically relevant reduction in pain with antacid alone goes against previous studies on the treatment of dyspepsia. A bias in the interviewer or population could have skewed their finding that the gastrointestinal cocktail is more effective. With this added the best evidence shows no clinical diiference in either treatment.

      Clinical bottomline

      Antacid alone should be preferred in treatment of dyspesia. The addition of lidocaine and donnatal can be used on doctor’s discretion in patients without contraindications to these agents.

      Table 2

      Report by Jason Bowman, Resident Physician.Search checked by Jeffrey Jones, Staff PhysicianGrand Rapids Medical Education Research Center, Michigan, USA

      References


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