Maintenance treatment of duodenal ulceration: ranitidine 300 mg at night is better than 150 mg in cigarette smokers

Article Abstract:

A common treatment strategy for duodenal ulcer is to suppress either the secretion or destructive potential of gastric acid. One class of drugs that is extensively used to block gastric acid secretion is histamine H2 blockers, which interfere with a key step in the secretion of acid. Ranitidine, a member of this class, is commonly prescribed for duodenal ulcer, where it is extremely effective in eradicating the symptoms of the disease. Relapse occurs in approximately 90 percent of patients during the 12 months following cessation of therapy. Therefore, maintenance therapy (continuous lower doses) is used to prevent recurrence. In spite of continuing administration, ulcer recurrence occurs in 20 to 35 percent of patients on maintenance therapy. To determine whether doubling the maintenance dosage of ranitidine would decrease the rate of recurrence, a study was carried out involving 200 patients who were to receive a maintenance dose of ranitidine. Patients were evenly divided into groups receiving either 150 milligrams (mg) per day (the standard dose) or 300 mg per day, administered before bedtime. Ulcer recurrence rates were lower in patients receiving the high-dose of ranitidine compared with the low-dose group (3.1 percent and 9.7 percent, respectively at six months; comparable differences were seen at 12 and 18 months). Among the subjects receiving the lower dosage of ranitidine, more recurrences were noted among smokers than non-smokers. Recurrence rates were similar among smokers and non-smokers in the high-dose group. For maintenance therapy for duodenal ulcer, 300 mg of ranitidine is recommended for smokers and for those who relapse with the lower dose. (Consumer Summary produced by Reliance Medical Information, Inc.)

Physiological aspects, Smoking, Control, Dosage and administration, Antiulcer agents, Gastric acid, Duodenal ulcer, Antiulcer drugs

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Treatment of refractory peptic ulcer with omeprazole or continued H2 receptor antagonists: a controlled clinical trial

Article Abstract:

Peptic ulcer is an inflammatory condition affecting the stomach and small intestine, characterized by gnawing pain, heartburn, nausea, and in severe cases, perforation, bleeding, and death. The cause varies from case to case, but ultimately results from an imbalance between the destructive effects of gastric acid and the protective effects of the mucous secreted by the lining of the gastrointestinal tract. Treatment commonly takes the form of drugs to suppress gastric acid secretion. Some cases of peptic ulcer (between 5 and 10 percent) do not respond to histamine H2 blockers within two to three months. To determine whether omeprazole, as a result of its different mode of action in the inhibition of gastric acid secretion, would be effective in these refractory cases, 107 patients with such a condition were randomly assigned to either continue receiving H2 blocker treatment, or to switch to omeprazole. Treatment was continued for eight weeks. Patients who began receiving omeprazole showed significantly greater rates of healing than those who continued to receive H2 blockers (85 percent vs. 34 percent at four weeks; 96 percent vs. 75 percent at eight weeks, respectively). Of the 22 patients whose ulcers were not healed by continuing H2 blocker therapy, 21 healed in four to eight weeks when switched to omeprazole treatment. Side effects of the drugs were infrequent in both groups. (Consumer Summary produced by Reliance Medical Information, Inc.)

Methods, Clinical trials, Antihistamines

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Double blind comparative study of omeprazole and ranitidine in patients with duodenal or gastric ulcer: a multicentre trial

Article Abstract:

Histamine is a hormone that stimulates the secretion of acid from certain stomach cells. Drugs that block histamine action in the stomach, histamine H2 blockers, have been widely and successfully used to treat stomach ulcers, with healing occurring at a rate of 80 percent after four weeks of ranitidine (an H2 blocker). Omeprazole is a drug which decreases acid secretion by a different method, and was more effective in treating ulcers than ranitidine in preliminary studies. A more extensive study of the two drugs has been completed. The proportion of healed ulcers after treatment with each drug was studied in 194 patients (51 women) with duodenal (junction between stomach and small intestine) or gastric (stomach) ulcers. Omeprazole provided better healing, especially during the first two weeks. At two and at four weeks, the percent of ulcers healed by omeprazole was 68 and 99, respectively. After two and after four weeks of ranitidine treatment, the percent of ulcers healed was 48 and 88, respectively. This is probably related to the greater effectiveness of omeprazole in suppressing acid secretion. Patients reported less pain with omeprazole, as well. The ulcer recurrence rates were similar for each drug. (Consumer Summary produced by Reliance Medical Information, Inc.)

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