In this episode, I’ll discuss a study of the treatment of dyspepsia in patients who present to the emergency department.
The use of a “GI Cocktail” with varying ingredients is popular in emergency departments both to treat dyspepsia and to attempt to distinguish nonischemic from ischemic chest pain.
This is a long-standing practice that goes back more than 3 decades.
GI Cocktails have traditionally contained a mixture of Donnatal, antacid, and viscous lidocaine. When Donnatal liquid became unavailable, the mixture was continued with antacid and viscous lidocaine.
It is now generally accepted that these GI cocktails are of no diagnostic value in distinguishing nonischemic from ischemic chest pain. This is because a patient with ischemic chest pain can present with dyspepsia that resolves with a GI cocktail. However the use of antacid plus viscous lidocaine continues for the treatment of dyspepsia in the ED.
A research letter was recently published in Academic Emergency Medicine detailing a randomized controlled trial looking at antacid alone vs viscous lidocaine plus antacid mixture vs lidocaine solution plus antacid mixture.
This was a single-center study that took place in Australia.
Data from 89 patients split nearly evenly across the 3 groups were analyzed.
There was not a statistically significant difference between groups for the primary outcome of analgesia. The lidocaine groups had incidences of oral numbness greater than 20%, and palatability was greater in the antacid only group.
The study was not perfect, as enrollment did not take place during the overnight shift, leaving a possibility of selection bias. Also, while the treating physician and investigators were blinded, nurses in the study were unblinded and a patient could easily become unblinded due to the distinct and unpleasant taste of oral lidocaine.
Despite these limitations, the results of this study are in line with another previous small randomized trial conducted in 2003.
This study has been heralded as “The Death of the GI Cocktail” however it is remarkably similar to the study from 2003 that also favored antacid alone. Perhaps with the current era of social media and faster knowledge translation, the results from this study will stick.
— Steve Trumble (@SteveTrumble) September 28, 2020
— Ken Milne MD (@TheSGEM) September 27, 2020
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