Prevention of Stress Related Mucosal Disease with Intermittent
Background: This study aimed to compare intermittent intravenous (IV) pantoprazole and ranitidine for control of gastric acid secretion and the possible prevention of Upper Gastrointestinal Bleeding (UGIB) in critical care patients.
Methods: This was a randomized, double blind clinical trial study of IV pantoprazole (40 mg every12 hour) or intermittent IV ranitidine (50 mg bolus every 8 hour) in patients at risk for UGIB. The primary endpoint was gastric pH. UGIB was measured as secondary endpoint.
Results: ninety two Critical care patients were enrolled. Gastric pH was well controlled by two study drugs. Gastric pH increased in pantoprazole group than in the ranitidine group (4.40±0.39 versus 3.32±0.28; P=0.000). Upper GI bleeding was higher in ranitidine group than pantoprazole group (4/46 versus 2/46; P=0.404).
Conclusion: This study indicates that intermittent IV pantoprazole compared with bolus IV ranitidine, more effectively controls gastric pH and may prevent UGIB in high risk critical care patients without the development of tolerance.
Somberg L, Morris Jr., Fantus R, et al. Intermittent intravenous pantoprazole and continuous cimetidine infusion: effect on gastric pH control in critically ill patients at risk of developing stress-related mucosal disease. J Trauma 2008; 64(5):1202-10.
Marrone GC, Silen W. Pathogenesis, diagnosis and treatment of acute gastric mucosal lesions. Clin Gastroenterol 1984; 13(2):635-50.
Hastings PR, Skillman JJ, Bushnell LS, Silen W. Antacid titration in the prevention of acute gastrointestinal bleeding: a controlled, randomized trial in 100 critically ill patients. N Engl J Med 1978; 298(19):1041-5.
Martin LF, Booth FV, Karlstadt RG, et al. Continuous intravenous cimetidine decreases stress-related upper gastrointestinal hemorrhage without promoting pneumonia. Crit Care Med 1993; 21(1):19-30.
Conrad SA, Gabrielli A, Margolis B, et al. Randomized, double-blind comparison of immediate-release omeprazole oral suspension versus intravenous cimetidine for the prevention of upper gastrointestinal bleeding in critically ill patients. Crit Care Med 2005; 33(4):760-5.
Brunner G, Chang J. Intravenous therapy with high doses of ranitidine and omeprazole in critically ill patients with bleeding peptic ulcerations of the upper intestinal tract: an open randomized controlled trial. Digestion 1990; 45(4):217-25.
Driks MR, Craven DE, Celli BR, et al. Nosocomial pneumonia in intubated patients given sucralfate as compared with antacids or histamine type 2 blockers. The role of gastric colonization. N Engl J Med 1987; 317(22):1376-82.
Cook DJ, Laine LA, Guyatt GH, Raffin TA. Nosocomial pneumonia and the role of gastric pH: A meta-analysis. Chest 1991;100(1):7-13.
Netzer P, Gaia C, Sandoz M, et al. Effect of repeated injection and continuous infusion of omeprazole and ranitidine on intragastric pH over 72 hours. Am J Gastroenterol 1999; 94(2):351-7.
Wilder-Smith C, Halter F, Ernst T, et al. Loss of acid suppression during dosing with H2-receptor antagonists. Aliment Pharmacol Ther 1990; 4 (Suppl. 1):15-27.
Hurlimann S, Abbuhl B, Inauen W, Halter F. Comparison of acid inhibition by either oral high-dose ranitidine or omeprazole. Aliment Pharmacol Ther 1994; 8(2):193-201.