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.

Abstract

Background-In healthy subjects, continuous infusions of high dose ranitidine and omeprazole produce high intragastric pH values. Aim-To test the hypothesis that both drugs also maintain high intragastric pH values in patients with bleeding ulcers. Patients and 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 001% 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. (Gut 1997; 40: 36-41)

Effect of Intravenous Omeprazole on Recurrent Bleeding after Endoscopic Treatment of Bleeding Peptic Ulcers

“…Studies in white subjects have demonstrated that a high dose of omeprazole, like the one we used, can neutralize intragastric pH. [4][5][6] The parietal-cell mass in Asian subjects is smaller than that in white subjects. 24 We therefore did not consider pH monitoring necessary.…”

“…2 In a multicenter trial that compared famotidine infusion with placebo infusion in 1005 patients, the rate of recurrent bleeding was similar in the two groups. 3 In vivo studies have shown that a regimen that includes high doses of a proton-pump inhibitor maintains intragastric pH at a nearly neutral level 4,5 and inhibits acid production more effectively than does an infusion of H 2 -receptor antagonists. Furthermore, tolerance of the antisecretory effect of H 2 -receptor antagonists, with loss of pH control, develops during the 72-hour period of infusion.…”

Assessment of effectiveness of different dosage regimens of pantoprazole in controlling symptoms and healing esophageal lesions of patients with mild erosive esophagitis

“…However, since the effect of these drugs is limited to keeping intragastric pH above 4 during 6 of the 24 hours in a day, they provide disappointing results in terms of esophageal healing rate and even symptom relief (4,5) . Association of prokinetic agents to H2 receptor antagonists for the treatment of GERD has also failed to significantly improve therapeutic effectiveness, especially in more severe grades of reflux esophagitis (8) .…”

Oral Rabeprazole Administration on a Procedure Day Suppresses Bleeding After Endoscopic Submucosal Dissection for Gastric Neoplasms

“…Furthermore, the intragastric pH (G -pH) must be raised. For hemostasis when intragastric bleeding occurs, the G -pH must be raised above 6 7) . Gastric mucosal bleeding drops markedly at G -pH >6.4 8) .…”