Effect of intravenous ranitidine and omeprazole on intestinal absorption of water, sodium, and macronutrients in patients with intestinal resection.
BACKGROUND
H2 receptor blockers and proton pump inhibitors reduce intestinal output in patients with short bowel syndrome.


OBJECTIVE
To evaluate the effect of intravenous omeprazole and ranitidine on water, electrolyte, macronutrient, and energy absorption in patients with intestinal resection.


METHODS
Thirteen patients with a faecal weight above 1.5 kg/day (range 1.7-5.7 kg/day and a median small bowel length of 100 cm were studied. Omeprazole 40 mg twice daily or ranitidine 150 mg twice daily were administered for five days in a randomised, double blind, crossover design followed by a three day control period with no treatment. Two patients with a segment of colon in continuation were excluded from analysis which, however, had no influence on the results.


RESULTS
Omeprazole increased median intestinal wet weight absorption compared with no treatment and ranitidine (p<0.03). The effect of ranitidine was not significant. Four patients with faecal volumes below 2.6 kg/day did not respond to omeprazole; in two absorption increased by 0.5-1 kg/day; and in five absorption increased by 1-2 kg/day. Absorption of sodium, calcium, magnesium, nitrogen, carbohydrate, fat, and total energy was unchanged. Four high responders continued on omeprazole for 12-15 months, but none could be weaned from parenteral nutrition.


CONCLUSIONS
Omeprazole increased water absorption in patients with faecal output above 2.50 kg/day. The effect varied significantly and was greater in patients with a high output, but did not allow parenteral nutrition to be discontinued. Absorption of energy, macronutrients, electrolytes, and divalent cations was not improved. The effect of ranitidine was not significant, possibly because the dose was too low.
Jeppesen
P B
PB
Department of Medicine CA, Section of Gastroenterology 2121, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, Denmark.
Staun
M
M
Tjellesen
L
L
Mortensen
P B
PB
D000328:Adult; D000897:Anti-Ulcer Agents / Q000008:administration & dosage*; D018592:Cross-Over Studies; D004311:Double-Blind Method; D004734:Energy Metabolism; D005243:Feces / Q000737:chemistry; D005260:Female; D006635:Histamine H2 Antagonists / Q000008:administration & dosage*; D006801:Humans; D007081:Ileostomy / Q000379:methods; D007408:Intestinal Absorption / Q000187:drug effects*; D007582:Jejunostomy / Q000379:methods; D008297:Male; D008875:Middle Aged; D009853:Omeprazole / Q000008:administration & dosage*; D011899:Ranitidine / Q000008:administration & dosage*; D012778:Short Bowel Syndrome / Q000378:metabolism* / Q000601:surgery; D012982:Sodium, Dietary / Q000378:metabolism; D014867:Water / Q000378:metabolism
D000897:Anti-Ulcer Agents; D006635:Histamine H2 Antagonists; D012982:Sodium, Dietary; D014867:Water; D011899:Ranitidine; D009853:Omeprazole