Comparison of Omeprazole and Ranitidine for Stress Ulcer Prophylaxis

Abstract

Stress ulcer prophylaxis protects againstclinically important gastrointestinal bleeding and hasgained widespread use. This study compares the efficacyof omeprazole to ranitidine for this indication. This was a prospective, randomized clinicaltrial. Sixty-seven high-risk patients were randomized toreceive either ranitidine 150 mg (N = 35) intravenouslydaily or omeprazole 40 mg (N = 32) daily orally or by nasogastric route. Patients weremonitored for clinically important bleeding. There wasno statistically significant difference betweentreatment groups in the number of patients enrolled,gender, race, or age. The study groups were comparablein regard to the severity of illness based on theirsimilar APACHE II score, duration of ICU stay, durationof ventilator dependence, and mortality rate. A significant difference was found only in regardto the number of risk factors per patient. Theranitidinetreated group had 2.7 risk factors per patientwhile the omeprazole-treated group had 1.9 (P <0.05). Eleven patients (31%) given ranitidine and twopatients (6%) given omeprazole developed clinicallyimportant bleeding (P < 0.05). Nosocomial pneumoniadeveloped in five patients (14%) receiving ranitidine and one patient (3%) receiving omeprazole (P< 0.05). We conclude that oral omeprazole is safe,effective, and clinically feasible for stress ulcerprophylaxis.

REFERENCES

  1. 1.

    Schuster DP: Stress ulcer prophylaxis: In whom? with what? Crit Care Med 21:4–6, 1993

    Google Scholar 

  2. 2.

    Lacroix J, Infante-Rivard C, Jenicek M, Gauthier M: Prophylaxis of upper gastrointestinal bleeding in intensive care units: A meta-analysis. Crit Care Med 17:862–869, 1989

    Google Scholar 

  3. 3.

    Morris DL, Markham SJ, Beechey A, Hicks F, Summers K, Lewis P: Ranitidine—bulos or infusion prophylaxis for stress ulcer. Crit Care Med 16:229–232, 1988

    Google Scholar 

  4. 4.

    Priebe HJ, Skillman JJ, Bushnell HS, Long PC, Silen W: Antacid versus cimetidine in preventing acute gastrointestinal bleeding. A randomized trial in 75 critically ill patients. N Engl J Med 302: 426–430, 1980

    Google Scholar 

  5. 5.

    Soll AH: Gastric, duodenal and stress ulcers. In Gastrointestinal Disease: Pathophysiology, Diagnosis and Management, 5th ed. MH Sleisenger JS Fordtran (eds). Philadelphia, WB Saunders, 1993, pp 580–679

    Google Scholar 

  6. 6.

    Tryba M: Sucralfate versus antacids or H2-antagonists for stress ulcer prophylaxis: A meta-analysis on efficacy and pneumonia rate. Crit Care Med 19:942–949, 1991

    Google Scholar 

  7. 7.

    Tryba M, Zevounou F, Torok M, Zenz M: Prevention of acute stress bleeding with sucralfate, antacids, or cimetidine. A controlled study with pirenzepine as a basic medication. Am J Med 79(suppl 2C):55–61, 1985

    Google Scholar 

  8. 8.

    Basso N, Bagarani M, Materia A, Fiorani S, Lunardi P, Speranze V: Cimetidine and antacid prophylaxis of acute upper gastrointestinal bleeding in high risk patients. Controlled, randomized trial. Am J Surg 141:339–341, 1981

    Google Scholar 

  9. 9.

    Cook DJ, Fuller HD, Guyatt GH, Marshall JC, Leasa D, Hall R, Winton TL, Rutledge F, Todd TJR, Roy P, Lacroix J, Griffith L, Willan A: Risk factors for gastrointestinal bleeding in critically ill patients. N Engl J Med 330:377–381, 1994

    Google Scholar 

  10. 10.

    Pinilla JC, Oleniuk FH, Reed D, Malik B, Laverty WH: Does antacid prophylaxis prevent upper gastrointestinal bleeding in critically ill patients? Crit Care Med 13:646–650, 1985

    Google Scholar 

  11. 11.

    Derrida S, Nury B, Slama R, Marois F, Moreau R, Soupison T, Sicot C: Occult gastrointestinal bleeding in high-risk intensive care unit patients receiving antacid prophylaxis: Frequency and significance. Crit Care Med 17:122–125, 1989

    Google Scholar 

  12. 12.

    Friedman CJ, Oblinger MJ, Suratt PM, Bowers J, Goldberg SK, Sperling MH, Blitzer AH: Prophylaxis of upper gastrointestinal hemorrhage in patients requiring mechanical ventilation. Crit Care Med 10:316–319, 1982

    Google Scholar 

  13. 13.

    Hastings PR, Skillman JJ, Bushnell LS, Silen W: Antacid titration in the prevention of acute gastrointestinal bleeding. A controlled, ran domized trial in 100 critically ill patients. N Engl J Med 298:1041–1045, 1978

    Google Scholar 

  14. 14.

    Czaja AJ, McAlhany JC, Pruitt BA Jr: Acute gastroduodenal disease after thermal injury: An endoscopic evaluation of incidence and natural history. N Engl J Med 291:925–929, 1974

    Google Scholar 

  15. 15.

    Speranza U, Basso N, Bayarani M.: Prevention of bleeding with cimetidine. In Cimetidine in the 80's. JH Baron (ed). Edinburgh, Churchill Livingstone, 1981, pp 185–189

    Google Scholar 

  16. 16.

    Maier RV, Mitchell D, Gentilello L: Optimal therapy for stress gastritis. Ann Surg 220:353–363, 1994

    Google Scholar 

  17. 17.

    Mead J, Folk F: Gastrointestinal bleeding after cardiac surgery. N Engl J Med 281:799, 1969 (letter)

    Google Scholar 

  18. 18.

    Shuman RB, Schuster DP, Zuckerman GR: Prophylactic therapy for stress ucler bleeding: A reappraisal. Ann Intern Med 106:562–567, 1987

    Google Scholar 

  19. 19.

    Fellenius E, Berglindh T, Sachs G, Olbe L, Elander B, Sjöstrand SE: Substituted benzimidazoles inhibit gastric acid secretion by blocking (H+, K+)ATPase. Nature 290:150–161, 1981

    Google Scholar 

  20. 20.

    Cook DJ, Pearl RG, Cook RJ, Guyatt GH: Incidence of clinically important bleeding in mechanically ventilated patients. J Intensive Care Med 6:167–174, 1991

    Google Scholar 

  21. 21.

    Walt RP, Gomes M de FA, Wood EC, Logan LH, Pounder RE: Effect of daily oral omeprazole on 24 hour intragastric acid. Br Med J 287:12–14, 83

  22. 22.

    Sharma BK, Walt RP, Pounder RE, Gomes M de FA, Wood EC, Logan LH: Optimal dose of oral omeprazole for maximal 24 hour decrease of intragastric acidity. Gut 25:957–964, 1984

    Google Scholar 

  23. 23.

    Physicians' Desk Reference, 49th ed. Montvale, N, Medical Economics Data; 1995, pp 546–549, 1106–1110

  24. 24.

    Olin BR (ed): Drug Facts and Comparison, 48th ed. St. Louis, MO, Facts and Comparison, 1994, pp 1664–1684

    Google Scholar 

  25. 25.

    Lipsy RJ, Fennerty B, Fagan TC: Clinical review of histamine2 receptor antagonists. Arch Intern Med 150:745–751, 1990

    Google Scholar 

  26. 26.

    Walt RP, Reynolds JR, Langman MJS, Smart HL, Kitchingman G, Somerville KW, Hawkey CJ: Intravenous omeprazole rapidly raises intragastric pH. Cut 26:902–906, 1985

    Google Scholar 

  27. 27.

    Feldman M, Burton ME: Histamine2-receptor antagonists: Standard therapy for acid-peptic diseases. N Engl J Med 323:1749–1755, 1990

    Google Scholar 

  28. 28.

    Peura DA, Koretk RL: Prophylactic therapy of stress-related mucosal damage: Why, which, who and so what? Am J Gastroenterol 85:935–937, 1990

    Google Scholar 

  29. 29.

    Knaus WA, Draper EA, Wagner DP, Zimmerman JE: APACHE II: A severity of disease classification system. Crit Care Med 13:818–829, 1985

    Google Scholar 

  30. 30.

    Karlstadt RG, Palmer RH: Continuous infusion H2-receptor therapy. Crit Care Med 18:1193–1194, 1990

    Google Scholar 

  31. 31.

    Karlstadt R, Herson J, Palmer R, Frank W, Young M: Cimetidine reduces upper gastrointestinal bleeding and nosocomial pneumonia in intensive care unit patients. Am J Gastroenterol 84:1162, 1989

    Google Scholar 

  32. 32.

    Reid SR, Bargliff CD: The comparative efficacy of cimetidine and ranitidine in controlling gastric pH in critically ill patients. Can Anesth Soc J 33:287, 1986

    Google Scholar 

  33. 33.

    Martin LF, Max MH, Polk HC Jr: Failure of gastric pH control by antacids or cimetidine in the critically ill: A valid sign of sepsis. Surgery 88:59–68, 1980

    Google Scholar 

  34. 34.

    Reines DH: Do we need stress ulcer prophylaxis? Crit Care Med 18:344, 1990

    Google Scholar 

  35. 35.

    Ben-Menachem T, Fogel R, Patel RV, Touchette M, Zarowitz BJ, Hadzijahic N, Divine G, Verter J, Bresalier RS: Prophylaxis for stress-related gastric hemorrhage in the medical intensive care unit. Ann Intern Med 121:568–575, 1994

    Google Scholar 

  36. 36.

    Peura DA, Johnson LF: Cimetidine for prevention and treatment of gastroduodenal mucosal lesions in patients in an intensive care unit. Ann Intern Med 103:173–177, 1985

    Google Scholar 

  37. 37.

    Skillman J, Bushnell LS, Goldman H, Silen W: Respiratory failure, hypotension, sepsis, and jaundice: A clinical syndrome associated with lethal hemorrhage from acute stress ulcer of the stomach. Am J Surg 117:523–530, 1069

    Google Scholar 

  38. 38.

    Bank S, Misra P, Mausner D, Kurtz L, Rehman M, Wise L: The incidence, distribution and evolution of stress ulcers in surgical intensive care patients. Am J Gastroenterol 74:76, 1980

    Google Scholar 

  39. 39.

    Marrone GL, Silen W: Pathogenesis, diagnosis, and treatment of gastroduodenal lesions. Clin Gastroenterol 13:635–650, 1984

    Google Scholar 

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Levy, M.J., Seelig, C.B., Robinson, N.J. et al. Comparison of Omeprazole and Ranitidine for Stress Ulcer Prophylaxis. Dig Dis Sci 42, 1255–1259 (1997). https://doi.org/10.1023/A:1018810325370

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  • STRESS ULCER PROPHYLAXIS
  • RANITIDINE
  • OMEPRAZOLE