Gastro-oesophageal reflux during 3 months of therapy with ranitidine in reflux oesophagitis.
BACKGROUND
Tolerance has been shown to develop in duodenal ulcer patients receiving H2-receptor antagonists, particularly with increased doses. Development of tolerance to ranitidine and its possible consequences for oesophageal acid load in patients with gastro-oesophageal reflux disease has still to be established.


METHODS
Eighteen patients with reflux oesophagitis grade 1 were treated with 300 mg ranitidine twice daily for 3 months and examined with two-channel 23-h pH-metry in the distal oesophagus and gastric body at base line and after 3 days and 3 months. Gastric infection with Helicobacter pylori was assessed with the 14C urea breath test.


RESULTS
Median 23-h gastric pH increased significantly from 1.5 at base line to 3.7 on day 3 and 2.8 after 3 months but decrease significantly from day 3 to month 3 of therapy. Median 23-h acid reflux time was reduced significantly by therapy, from 12.6% at base line to 6.2% on day 3 and 7.2% after 3 months, and there was no significant difference between day 3 and month 3. Although there was no significant change in commonly used indicators of gastro-oesophageal reflux, interindividual variation was great, and multiple linear regression analysis indicated that tolerance, expressed as change in median gastric pH, was related to individual changes in 23-h acid reflux time with a correlation coefficient of -0.43. Infection with H. pylori was diagnosed in 44% of patients and was negatively related to tolerance.


CONCLUSIONS
Our group of patients developed tolerance to the effect of ranitidine on gastric acidity. While gastro-oesophageal reflux did not change significantly in the group, tolerance may seen to contribute to increased gastro-oesophageal reflux in individual patients.
Medical Dept. A, Haukeland Sykehus, University of Bergen, Norway.
J G
JG
Hatlebakk
A
A
Berstad
D000328:Adult; D000368:Aged; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004361:Drug Tolerance; D004942:Esophagitis, Peptic / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D004945:Esophagoscopy; D005260:Female; D005764:Gastroesophageal Reflux / Q000150:complications / Q000188:drug therapy*; D006635:Histamine H2 Antagonists / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D006863:Hydrogen-Ion Concentration / Q000187:drug effects; D008297:Male; D008875:Middle Aged; D011899:Ranitidine / Q000008:administration & dosage / Q000627:therapeutic use*; D012044:Regression Analysis; D016896:Treatment Outcome
D006635:Histamine H2 Antagonists; D011899:Ranitidine