Digestive Diseases and Sciences

, Volume 37, Issue 4, pp 570–576 | Cite as

Correlation between basal acid output and daily ranitidine dose required for therapy in Barrett's esophagus

  • Martin J. Collen
  • David A. Johnson
Original Article

Abstract

We prospectively evaluated basal gastric acid secretion in 42 consecutive patients with Barrett's esophagus to determine the optimal dose requirement for an H2-receptor antagonist in relation to the gastric acid secretory status of each patient. All patients with Barrett's esophagus had pyrosis and 31 of the 42 patients had erosive esophagitis. Mean extension of Barrett's epithelium was 6.9 cm (range 2–17 cm). Mean basal acid output for the patients with Barrett's esophagus was 8.0±5.2 meq/hr, which was significantly different compared to a group of 65 normal subjects with mean basal acid output of 3.0 ±2.7 meq/hr (P<0.001). There was no correlation between basal acid output and extension of Barrett's epithelium. All patients with Barrett's esophagus were treated with ranitidine, with 24 requiring standard-dose (300 mg/day) and 18 requiring increased doses (mean 1170 mg/day, range 600–2400 mg/day) for complete healing of esophagitis and disappearance of pyrosis. There was a significant correlation between basal acid output and daily ranitidine dose required for therapy (r=0.52,P<0.001). Fifteen of the 42 patients with Barrett's esophagus (36%) had gastric acid hypersecretion. There was a significant association between gastric acid hypersecretion defined as a basal acid output of greater than 10.0 meq/hr and a requirement for increased daily ranitidine doses (greater than 300 mg/day) (P<0.0002). No side effects occurred with any of these high doses of ranitidine. We conclude that as a group, patients with Barrett's esophagus have significantly higher basal acid outputs than normal subjects and many require increased therapeutic doses of ranitidine. Furthermore, there is a significant correlation between basal acid output and therapeutic daily ranitidine dose and a significant association between gastric acid hypersecretion and the requirement for increased daily ranitidine doses.

Key Words

acid secretion ranitidine Barrett's esophagus 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Spechler SJ, Goyal RK: Barrett's esophagus. N Engl J Med 315:362–371, 1986Google Scholar
  2. 2.
    Winters C, Spurling TJ, Chobanian SJ, Curtis DJ, Esposito RL, Hacker JF, Johnson DA, Cruess DF, Cotelingam JD, Gurney MS, Cattau EL: Barrett's esophagus: A prevalent, occult complication of gastroesophageal reflux disease. Gastroenterology 92:118–124, 1987Google Scholar
  3. 3.
    Mann NS, T Sai MF, Nair PK: Barrett's esophagus in patients with symptomatic reflux esophagitis. Am J Gastroenterol 84:1494–1496, 1989Google Scholar
  4. 4.
    Fiorucci S, Santucci L, Farroni F, Pelli MA, Morelli A: Effect of omeprazole on gastroesophageal reflux on Barrett's esophagus. Am J Gastroenterol 84:1203–1267, 1989Google Scholar
  5. 5.
    Sontag S, Schnell T, O'Connel S, Serlovsky R, Nemchavsky B, Miller T: Esophageal acid reflux profiles correlate with status of esophageal mucosa in gastroesophageal reflux and Barrett's. Gastroenterology 90:1643,1986 (abstract)Google Scholar
  6. 6.
    Iascone C, DeMeester TR, Little AG, Skinner DB: Barrett's esophagus: Functional assessment, proposed pathogenesis, and surgical therapy. Arch Surg 118:543–549, 1983Google Scholar
  7. 7.
    Holloway RH, Dodds WJ: Esophageal motor function in Barrett's esophagus.In Barrett's esophagus: Pathophysiology, Diagnosis, and Management. SJ Spechler, RK Goyal (eds). New York, Elsevier Science, pp 105–112, 1985Google Scholar
  8. 8.
    Collen MJ, Gallagher JE: Basal acid output and gastric acid hypersecretion in patients with gastroesophageal reflux disease. Gastroenterology 98:32, 1990 (abstract)Google Scholar
  9. 9.
    Johnson DA, Winters C, Spurling TJ, Chobanian SJ, Cattau EL: Esophageal acid sensitivity in Barrett's esophagus. J Clin Gastroenterol 9:23–27, 1987Google Scholar
  10. 10.
    Collen MJ, Lewis JH, Benjamin SB: Gastric acid hypersecretion in gastroesophageal reflux disease. Gastroenterology 98:654–661, 1990Google Scholar
  11. 11.
    Collen MJ, Johnson DA, Ciarleglio CA, Stanczak VJ, Benjamin SB: Correlationl between basal acid output and daily ranitidine dose in Barrett's esophagus. Gastroenterology 94:73, 1988 (abstract)Google Scholar
  12. 12.
    Knuff TE, Benjamin SB, Worsham F, Hancock JE, Castell DO: Histologic evaluation of chronic gastroesophageal reflux. An evaluation of biopsy methods and diagnostic criteria. Dig Dis Sci 29:194–201, 1984Google Scholar
  13. 13.
    Raufman J-P, Collins SM, Korman LY, Pandol SJ, Collen MJ, Cornelius MJ, Feld MK, McCarthy DM, Gardner JD, Jensen RT: Reliability of symptoms in assessing control of gastric acid secretion in patients with Zollinger-Ellison syndrome. Gastroenterology 84:108–113, 1983Google Scholar
  14. 14.
    Collen MJ, Stanczak VJ, Ciarleglio CA: Refractory duodenal ulcers (nonhealing duodenal ulcers with standard doses of antisecretory medication). Dig Dis Sci 34:233–237, 1989Google Scholar
  15. 15.
    Collen MJ, Sheridan MJ: Definition for idiopathic gastric acid hypersecretion: A statistical and functional evaluation. Dig Dis Sci 36:1371–1376, 1991Google Scholar
  16. 16.
    Wolfe MM, Jensen RT: Zollinger-Ellison syndrome. Current concepts in diagnosis and management. N Engl J Med 317:1200–1209, 1987Google Scholar
  17. 17.
    Cochran WG, Snedecor GW: Statistical Methods, 7th ed. Ames, Iowa, Iowa State University Press, 1980Google Scholar
  18. 18.
    Collen MJ, Kalloo AN, Lewis JH, Sheridan MJ: Bleeding duodenal ulcers: Significant association with gastric acid hypersecretion. Dig Dis Sci 1992 (in press)Google Scholar
  19. 19.
    Mulholland MW, Reid BJ, Levene DS, Rubin CE: Elevated gastric acid secretion in patients with Barrett's metaplastic epithelium. Dig Dis Sci 34:1329–1335, 1989Google Scholar
  20. 20.
    Spechler SJ: Barrett's esophagus: What's new and what to do. Am J Gastroenterol 84:220–223, 1989Google Scholar
  21. 21.
    Koelz HR, Birchler R, Bretholz A, Bron B, Capitaine Y, Delmore G, Fehr HF, Fumagalli I, Gehrig J, Gonvers JJ, Halter F, Hammer B, Kayasseh L, Kobler E, Miller G, Munst G, Pelloni S, Realini S, Schmid P, Voirol M, Blum AL: Healing and relapse of reflux esophagitis during treatment with ranitidine. Gastroenterology 91:1198–1205, 1986Google Scholar
  22. 22.
    Cooper BT, Barbezat GO: Treatment of Barrett's esophagus with H2 blockers. J Clin Gastroenterol 9:139–141, 1987Google Scholar
  23. 23.
    Saltzman M, Barwick K, McCallum RW: Progression of cimetidine-treated reflux esophagitis to a Barrett's stricture. Dig Dis Sci 27:181–186, 1982Google Scholar
  24. 24.
    Wesdorp ICE, Barthelsman J, Schepper MEI, Tytgat GN: Effects of long term treatment with cimetidine and antacids in Barrett's esophagus. Gut 22:724–727, 1981Google Scholar
  25. 25.
    Kisloff B: Cimetidine resistant gastric acid secretion in humans. Ann Intern Med 92:791–793, 1980Google Scholar
  26. 26.
    McCarthy DM, Peikin SR, Lopatin RN, Crossby RJ, Harpel HS: H2 receptor antagonists in gastric hypersecretory states. I: Cimetidine.In Proceedings of an International Symposium on Histamine H2 Receptor Antagonists. W Creutfeldt (ed). Amsterdam, Excerpta Medica, pp 153–164, 1978Google Scholar
  27. 27.
    Ziemniak JA, Madura M, Adamonis AJ, Glinger EJ, Dreyer M, Schentag JJ: Failure of cimetidine in Zollinger-Ellison syndrome. Dig Dis Sci 28:976–980, 1983Google Scholar
  28. 28.
    Steinberg WM, Lewis JH, Katz DM: Transient cimetidine resistance. J Clin Gastroenterol 6:355–359, 1984Google Scholar
  29. 29.
    Hunt RH: Non-responders to cimetidine treatment, part I.In Cimetidine in the 80's. JH Baron (ed). New York, Churchill Livingston, 1981, pp 34–41Google Scholar
  30. 30.
    Bardhan KD: Non-responders to cimetidine treatment, part 2.In Cimetidine in the 80's. JH Baron (ed). New York, Churchill Livingston, pp 42–57, 1981Google Scholar
  31. 31.
    Johnson DA, Kandasamij A, Ezra D, Peck C, Dobois A: Cimetidine pharmacokinetics and pharmacodynamics in Barrett's esophagus. Gastroenterology 92:1456, 1987 (abstract)Google Scholar
  32. 32.
    Lee FI, Isaacs PET: Barrett's ulcer: Response to standard dose ranitidine, high dose ranitidine and omeprazole. Am J Gastroenterol 83:914–916, 1988Google Scholar
  33. 33.
    Hameeteman W, Tytgat GN: Healing of chronic gastric ulcers on omeprazole. Am J Gastroenterol 81:764–766, 1986Google Scholar
  34. 34.
    Fiorucci S, Santucci L, Farrone F, Pelli MA, Morelli A: Effect of omeprazole on gastroesophageal reflux in Barrett's esophagus. Am J Gastroenterol 84:1263–1267, 1989Google Scholar
  35. 35.
    Collen MJ, Howard JM, McArthur KE, Raufman J-P, Cornelius MJ, Ciarleglio CA, Gardner JD, Jensen RT: Comparison of ranitidine and cimetidine in the treatment of gastric hypersecretion. Ann Intern Med 100:52–58, 1984Google Scholar
  36. 36.
    Howard JM, Chremos AN, Collen MJ, McArthur KE, Cherner JA, Maton PN, Ciarleglio CA, Cornelius MJ, Gardner JD, Jensen RT: Famotidine, a new potent, long-acting histamine H2-receptor antagonist: Comparison with cimetidine and ranitidine in the treatment of Zollinger-Ellison syndrome. Gastroenterology 88:1026–1033, 1985Google Scholar
  37. 37.
    Gelzayd EA, Maas LC: Barrett's esophagus and active duodenal ulcer: An important clinical association. South Med J 73:298–299, 1981Google Scholar
  38. 38.
    Hirschowitz BI: Gastric acid and pepsin secretion in esophagitis. Gastroenterology 96:212, 1989 (abstract)Google Scholar
  39. 39.
    Collen MJ, Strong RM: Comparison of omeprazole and ranitidine in the treatment of refractory gastroesophageal reflux disease in patients with gastric acid hypersecretion. Dig Dis Sci 1992 (in press)Google Scholar

Copyright information

© Plenum Publishing Corporation 1992

Authors and Affiliations

  • Martin J. Collen
    • 1
    • 2
  • David A. Johnson
    • 1
    • 2
  1. 1.Divisions of Gastroenterology, Departments of MedicineLoma Linda University Medical CenterLoma Linda
  2. 2.Naval HospitalBethesda

Personalised recommendations