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We conclude that both famotidine 10 mg and ranitidine 75 mg significantly raise intragastric pH when given as single post-prandial doses. Famotidine 10 mg may have a greater effect than ranitidine elixir 75 mg over the 5-9-h period after dosing.

To investigate the relative abilities of low doses of famotidine and cimetidine to raise intragastric pH after a single postprandial evening dose, 16 healthy volunteers were recruited to a four period crossover trial of famotidine 10 mg, cimetidine 100 mg and 200 mg compared with placebo. Intragastric pH was monitored between 1800 and 0730 with a nasogastric pH electrode. Median gastric pH rose from 1.35 (interquartile range 1-1-1-65) with placebo to 1 95 (1.6-5.35, p0.2) after cimetidine 100 mg. Intragastric pH was above 3 for 34% (p<0.005) of the time after dosing with famotidine, compared with 13.6% (p>0.2) after cimetidine 200 mg, 9.5% (p>02) after cimetidine 100 mg, and 4.7% after placebo. The rise of intragastric pH after famotidine 10 mg is significantly greater than that after either 200 mg or 100 mg cimetidine when the drugs are used postprandially. (Gut 1995; 37: 325-328) Keywords: H2 receptor antagonist, intragastric pH, famotidine, cimetidine. Study designThe investigation was designed as a four period crossover study with all subjects receiving the four different preparations in a random order. The study was partially blinded in that the drugs were recognisably different but the subjects were not aware of which was which. Of the two principal investigators one (RPW) was blinded to the drugs. There was a wash out period of at least six days between studies.On each study day subjects arrived at 1700 on the investigation unit having fasted for six hours. Bipolar glass pH electrodes (Ingold M440) were calibrated in standard buffer solutions of pH 7.00 and 4.01 and calibration was verified at pH 1.69. These electrodes were passed by the nasogastric route. A drop in pH to less than 2 was taken as evidence of the tip of the probe having entered the stomach, and the electrode was advanced a further 8 cm from this point. At 1830 a standard meal was given, which consisted of a supermarket ready meal of cottage pie, peas, and carrots, followed by chocolate coated ice cream and two chocolate mints to give a total of 700 kcal, provided by 22 g protein, 70 g carbohydrate, and 37 g fat, accompanied by 250 ml mineral water.

Background: Helicobacter pylori eradication for peptic ulcer has been widely taken up. Evidence for the efficacy of different regimens is often derived from small series in clinical trials but there is little reporting of everyday practice with unselected patients. Freedom from ulcer relapse has been demonstrated, but not whether this equates with clinical success. Methods: We report on a series of 706 patients with H. pylori infection who, between January 1991 and April 1995, received eradication therapy followed by assessment of H. pylori status. Two-hundred and seven of these patients were followed-up by postal questionnaire, validated by parallel questionnaires to their general practitioners, covering clinical outcome measures.Results: The overall eradication rate was 81.7%, and a 1-week course of omeprazole plus two antibiotics was significantly better than a 2-week course of standard triple therapy (85.0% vs. 78.0%, P < 0.05). Amongst 21 first-time failures, a 7-day course of a clarithromycin-containing triple therapy succeeded in 18. The questionnaire replies indicate that, following successful H. pylori eradication, ulcer patients are less likely to consult with ulcer symptoms ( P < 0.0005), take medication ( P < O.OOOSj, require further prescription ( P < 0.0005 j, or lose work-time because of their ulcer ( P < 0.005). They are more likely to have a subjective sense of ulcer cure (P < 0.0005).Conclusions: In addition to clear cost savings, social benefits are now demonstrated when H. pylori is eradicated. A well-tolerated 1 week regimen is genuinely effective in everyday practice.

Inhibition of gastric acidity over the 12 h post-dose period was significantly greater and endured longer after famotidine 10 mg than after effervescent cimetidine 200 mg, but for the 60 min period immediately after dosing the effect on intragastric pH was significant following effervescent cimetidine 200 mg but not famotidine 10 mg. This suggests effervescent formulations of H2-receptor antagonists with an acid buffer have a more rapid effect on intragastric pH than film-coated tablets.