Controlled study of the effects of intravenous famotidine on intragastric pH in bleeding peptic ulcers

Abstract

SUMMARY As blood coagulation and platelet aggregation are abolished at pH < 5.4 the failure of antisecretory drugs to promote haemostasis in bleeding peptic ulcers may reflect inadequate pH control. This study examined the ability of famotidine, a potent, long‐acting H2 blocker to maintain intragastric pH above 5.4 in patients presenting with bleeding peptic ulcers. Twenty patients with acute upper gastrointestinal haemorrhage confirmed endoscopically to be related to peptic ulceration (17 duodenal, 3 gastric ulcers), were entered into the study within 24 h of presentation. Each patient was randomly allocated to receive either intravenous famotidine (n= 10) administered as a 10 mg bolus followed by a constant infusion of 3.2 mg/h or similarly administered placebo (n= 10). All patients remained fasted over the 22‐h study period. Their median intragastric pH values ranged from 6.8 to 7.9 (median 7.1) in the famotidine group and from 1.1 to 6.9 (median 1.6) in the placebo group (P < 0.001). Over this same period intragastric pH was > 6 for 64%‐100% (median 98%) of the recording time in the famotidine group compared with 0%‐93% (median 13%) in the placebo group (P < 0.001). We conclude that intravenous famotidine can maintain intragastric pH > 6 in fasting patients with acute upper gastro‐intestinal bleeding from peptic ulceration. This provides a rational basis for further studies assessing its clinical efficacy in such patients.

Early effects of oral administration of omeprazole and roxatidine on intragastric pH

“…However, the intragastric pH necessary for protection against stress-related mucosal damage is not well established and, therefore, the optimal pH for the prevention of stress ulcers and bleeding is a subject for debate. Maintenance of the intragastric pH above 3.5 to 4.0 is thought to be necessary for preventing stress ulcers (Stothert et al, 1980;Frank et al, 1986;Watanabe et al, 1990), while an intragastric pH of over 6 is necessary for the treatment of existing stress ulcers (Fullarton et al, 1991). Our results show that a single oral administration of roxatidine produces a more rapid antisecretory effect as compared with omeprazole, and roxatidine may be suitable for initial therapy to promote hemostasis and for on-demand therapy in outpatients to relieve symptoms.…”