Efficacy of primed infusions with high dose ranitidine and omeprazole to maintain high intragastric pH in patients with peptic ulcer bleeding: a prospective randomised controlled study.
BACKGROUND
In healthy subjects, continuous infusions of high dose ranitidine and omeprazole produce high intragastric pH values.


OBJECTIVE
To test the hypothesis that both drugs also maintain high intragastric pH values in patients with bleeding ulcers.


METHODS
In two parallel studies, 20 patients with bleeding duodenal ulcers and 20 patients with bleeding gastric ulcers were randomly assigned to receive either ranitidine (0.25 mg/kg/hour after a bolus of 50 mg) or omeprazole (8 mg/hour after a bolus of 80 mg) for 24 hours. Intragastric pH was continuously recorded with a glass electrode placed 5 cm below the cardia.


RESULTS
Both drugs rapidly raised the intragastric pH above 6. During the second 12 hour period, however, the percentage of time spent below a pH of 6 was 0.15% with omeprazole and 20.1% with ranitidine (p = 0.0015) in patients with duodenal ulcer; in patients with gastric ulcer it was 0.1% with omeprazole and 46.1% with ranitidine (p = 0.002).


CONCLUSIONS
Primed infusions of omeprazole after a bolus produced consistently high intragastric pH values in patients with bleeding peptic ulcers, whereas primed infusions with ranitidine were less effective during the second half of a 24 hour treatment course. This loss of effectiveness may be due to tolerance.
Labenz
J
J
Department of Internal Medicine and Gastroenterology, Elisabeth Hospital, Essen, Germany.
Peitz
U
U
Leusing
C
C
Tillenburg
B
B
Blum
A L
AL
Börsch
G
G
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000897:Anti-Ulcer Agents / Q000008:administration & dosage*; D004381:Duodenal Ulcer / Q000150:complications*; D005260:Female; D006801:Humans; D006863:Hydrogen-Ion Concentration; D008297:Male; D008875:Middle Aged; D009853:Omeprazole / Q000008:administration & dosage*; D010438:Peptic Ulcer Hemorrhage / Q000188:drug therapy*; D011446:Prospective Studies; D011899:Ranitidine / Q000008:administration & dosage*; D012044:Regression Analysis; D013276:Stomach Ulcer / Q000150:complications*
D000897:Anti-Ulcer Agents; D011899:Ranitidine; D009853:Omeprazole