Skip to main content
PMC home page
Archives of Disease in Childhood logoLink to Archives of Disease in Childhood
. 1993 Dec;69(6):655–659. doi: 10.1136/adc.69.6.655

Omeprazole and high dose ranitidine in the treatment of refractory reflux oesophagitis.

S Cucchiara 1, R Minella 1, C Iervolino 1, M T Franco 1, A Campanozzi 1, M Franceschi 1, F D'Armiento 1, S Auricchio 1
PMCID: PMC1029648  PMID: 8285777

Abstract

Thirty two consecutive patients (age range 6 months-13.4 years) with severe reflux oesophagitis were randomised to a therapeutic trial for eight weeks during which they received either standard doses of omeprazole (40 mg/day/1.73 m2 surface area) or high doses of ranitidine (20 mg/kg/day). Twenty five patients completed the trial (12 on omeprazole, 13 on ranitidine). At entry and at the end of the trial patients underwent symptomatic score assessment, endoscopic and histological evaluation of the oesophagus, and simultaneous oesophageal and gastric pH measurement; results are given as median (range). Both therapeutic regimens were effective in decreasing clinical score (omeprazole before 24.0 (15-33), after 9.0 (0-18); ranitidine before 19.5 (12-33), after 9.0 (6-12)), in improving the histological degree of oesophagitis (omeprazole before 8.0 (6-10), after 2.0 (0-60); ranitidine before 8.0 (8-10), after 2.0 (2-6), and in reducing oesophageal acid exposure, measured as minutes of reflux at 24 hour pH monitoring (omeprazole before 129.4 (84-217), after 44.6 (0.16-128); ranitidine before 207.3 (66-306), after 58.4 (32-128)) as well as intragastric acidity, measured as median intragastric pH (omeprazole before 2.1 (1.0-3.0), after 5.1 (2.2-7.4); ranitidine before 1.9 (1.6-4), after 3.4 (2.3-5.3)). Serum gastrin concentration was > 150 ng/l in four patients on omeprazole and in three patients on ranitidine. It is concluded that in children with refractory reflux oesophagitis high doses of ranitidine are comparable with omeprazole for the healing of oesophagitis and relief of symptoms; both drugs resulted in efficacious reduction of intragastric acidity and intra-oesophageal acid exposure.

Full text

PDF
655

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Alumets J., El Munshid H. A., Håkanson R., Liedberg G., Oscarson J., Rehfeld J. F., Sundler F. Effect of antrum exclusion on endocrine cells of rat stomach. J Physiol. 1979 Jan;286:145–155. doi: 10.1113/jphysiol.1979.sp012610. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Bardhan K. D., Morris P., Thompson M., Dhande D. S., Hinchliffe R. F., Jones R. B., Daly M. J., Carroll N. J. Omeprazole in the treatment of erosive oesophagitis refractory to high dose cimetidine and ranitidine. Gut. 1990 Jul;31(7):745–749. doi: 10.1136/gut.31.7.745. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Bate C. M., Keeling P. W., O'Morain C., Wilkinson S. P., Foster D. N., Mountford R. A., Temperley J. M., Harvey R. F., Thompson D. G., Davis M. Comparison of omeprazole and cimetidine in reflux oesophagitis: symptomatic, endoscopic, and histological evaluations. Gut. 1990 Sep;31(9):968–972. doi: 10.1136/gut.31.9.968. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Bell N. J., Hunt R. H. Role of gastric acid suppression in the treatment of gastro-oesophageal reflux disease. Gut. 1992 Jan;33(1):118–124. doi: 10.1136/gut.33.1.118. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Berlin R. G. Omeprazole. Gastrin and gastric endocrine cell data from clinical studies. Dig Dis Sci. 1991 Feb;36(2):129–136. doi: 10.1007/BF01300745. [DOI] [PubMed] [Google Scholar]
  6. Boyle J. T. Gastroesophageal reflux in the pediatric patient. Gastroenterol Clin North Am. 1989 Jun;18(2):315–337. [PubMed] [Google Scholar]
  7. Brunner G., Creutzfeldt W., Harke U., Lamberts R. Therapy with omeprazole in patients with peptic ulcerations resistant to extended high-dose ranitidine treatment. Digestion. 1988;39(2):80–90. doi: 10.1159/000199610. [DOI] [PubMed] [Google Scholar]
  8. Brunner G., Creutzfeldt W. Omeprazole in the long-term management of patients with acid-related diseases resistant to ranitidine. Scand J Gastroenterol Suppl. 1989;166:101–113. doi: 10.3109/00365528909091254. [DOI] [PubMed] [Google Scholar]
  9. Collen M. J., Lewis J. H., Benjamin S. B. Gastric acid hypersecretion in refractory gastroesophageal reflux disease. Gastroenterology. 1990 Mar;98(3):654–661. doi: 10.1016/0016-5085(90)90285-9. [DOI] [PubMed] [Google Scholar]
  10. Dehn T. C., Shepherd H. A., Colin-Jones D., Kettlewell M. G., Carroll N. J. Double blind comparison of omeprazole (40 mg od) versus cimetidine (400 mg qd) in the treatment of symptomatic erosive reflux oesophagitis, assessed endoscopically, histologically and by 24 h pH monitoring. Gut. 1990 May;31(5):509–513. doi: 10.1136/gut.31.5.509. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Dent J. Recent views on the pathogenesis of gastro-oesophageal reflux disease. Baillieres Clin Gastroenterol. 1987 Oct;1(4):727–745. doi: 10.1016/0950-3528(87)90016-9. [DOI] [PubMed] [Google Scholar]
  12. Fimmel C. J., Etienne A., Cilluffo T., von Ritter C., Gasser T., Rey J. P., Caradonna-Moscatelli P., Sabbatini F., Pace F., Bühler H. W. Long-term ambulatory gastric pH monitoring: validation of a new method and effect of H2-antagonists. Gastroenterology. 1985 Jun;88(6):1842–1851. doi: 10.1016/0016-5085(85)90009-5. [DOI] [PubMed] [Google Scholar]
  13. Fonkalsrud E. W., Foglia R. P., Ament M. E., Berquist W., Vargas J. Operative treatment for the gastroesophageal reflux syndrome in children. J Pediatr Surg. 1989 Jun;24(6):525–529. doi: 10.1016/s0022-3468(89)80498-1. [DOI] [PubMed] [Google Scholar]
  14. Havelund T., Laursen L. S., Skoubo-Kristensen E., Andersen B. N., Pedersen S. A., Jensen K. B., Fenger C., Hanberg-Sørensen F., Lauritsen K. Omeprazole and ranitidine in treatment of reflux oesophagitis: double blind comparative trial. Br Med J (Clin Res Ed) 1988 Jan 9;296(6615):89–92. doi: 10.1136/bmj.296.6615.89. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Hetzel D. J., Bonnin M. Long term management of hemorrhagic esophagitis with cimetidine and omeprazole. Aust N Z J Med. 1986 Apr;16(2):226–228. doi: 10.1111/j.1445-5994.1986.tb01156.x. [DOI] [PubMed] [Google Scholar]
  16. Hetzel D. J., Dent J., Reed W. D., Narielvala F. M., Mackinnon M., McCarthy J. H., Mitchell B., Beveridge B. R., Laurence B. H., Gibson G. G. Healing and relapse of severe peptic esophagitis after treatment with omeprazole. Gastroenterology. 1988 Oct;95(4):903–912. doi: 10.1016/0016-5085(88)90162-x. [DOI] [PubMed] [Google Scholar]
  17. Holloway R. H., Orenstein S. R. Gastro-oesophageal reflux disease in adults and children. Baillieres Clin Gastroenterol. 1991 Jun;5(2):337–370. doi: 10.1016/0950-3528(91)90033-w. [DOI] [PubMed] [Google Scholar]
  18. Jansen J. B., Klinkenberg-Knol E. C., Meuwissen S. G., De Bruijne J. W., Festen H. P., Snel P., Lückers A. E., Biemond I., Lamers C. B. Effect of long-term treatment with omeprazole on serum gastrin and serum group A and C pepsinogens in patients with reflux esophagitis. Gastroenterology. 1990 Sep;99(3):621–628. doi: 10.1016/0016-5085(90)90946-x. [DOI] [PubMed] [Google Scholar]
  19. Klinkenberg-Knol E. C., Jansen J. M., Festen H. P., Meuwissen S. G., Lamers C. B. Double-blind multicentre comparison of omeprazole and ranitidine in the treatment of reflux oesophagitis. Lancet. 1987 Feb 14;1(8529):349–351. doi: 10.1016/s0140-6736(87)91726-0. [DOI] [PubMed] [Google Scholar]
  20. Lambert J., Mobassaleh M., Grand R. J. Efficacy of cimetidine for gastric acid suppression in pediatric patients. J Pediatr. 1992 Mar;120(3):474–478. doi: 10.1016/s0022-3476(05)80924-2. [DOI] [PubMed] [Google Scholar]
  21. Lanzon-Miller S., Pounder R. E., Hamilton M. R., Chronos N. A., Ball S., Mercieca J. E., Olausson M., Cederberg C. Twenty-four-hour intragastric acidity and plasma gastrin concentration in healthy subjects and patients with duodenal or gastric ulcer, or pernicious anaemia. Aliment Pharmacol Ther. 1987 Jun;1(3):225–237. doi: 10.1111/j.1365-2036.1987.tb00622.x. [DOI] [PubMed] [Google Scholar]
  22. Larsson H., Håkanson R., Mattsson H., Ryberg B., Sundler F., Carlsson E. Omeprazole: its influence on gastric acid secretion, gastrin and ECL cells. Toxicol Pathol. 1988;16(2):267–272. doi: 10.1177/019262338801600220. [DOI] [PubMed] [Google Scholar]
  23. Lind T., Cederberg C., Idström J. P., Lönroth H., Olbe L., Lundell L. 24-hour intragastric acidity and plasma gastrin during long-term treatment with omeprazole or ranitidine in patients with reflux esophagitis. Scand J Gastroenterol. 1991 Jun;26(6):620–626. doi: 10.3109/00365529109043636. [DOI] [PubMed] [Google Scholar]
  24. Lind T., Cederberg C., Olausson M., Olbe L. 24-hour intragastric acidity and plasma gastrin after omeprazole treatment and after proximal gastric vagotomy in duodenal ulcer patients. Gastroenterology. 1990 Dec;99(6):1593–1598. doi: 10.1016/0016-5085(90)90462-a. [DOI] [PubMed] [Google Scholar]
  25. Merki H. S., Witzel L., Walt R. P., Cohnen E., Harre K., Heim J., Mappes A., Röhmel J. Day-to-day variation of 24-hour intragastric acidity. Gastroenterology. 1988 Apr;94(4):887–891. doi: 10.1016/0016-5085(88)90543-4. [DOI] [PubMed] [Google Scholar]
  26. Moore E. W. Determination of pH by the glass electrode: pH meter calibration for gastric analysis. Gastroenterology. 1968 Apr;54(4):501–507. [PubMed] [Google Scholar]
  27. Orenstein S. R. Gastroesophageal reflux. Curr Probl Pediatr. 1991 May-Jun;21(5):193–241. doi: 10.1016/0045-9380(91)90066-t. [DOI] [PubMed] [Google Scholar]
  28. Ruth M., Enbom H., Lundell L., Lönroth H., Sandberg N., Sandmark S. The effect of omeprazole or ranitidine treatment on 24-hour esophageal acidity in patients with reflux esophagitis. Scand J Gastroenterol. 1988 Nov;23(9):1141–1146. doi: 10.3109/00365528809090182. [DOI] [PubMed] [Google Scholar]
  29. Sandmark S., Carlsson R., Fausa O., Lundell L. Omeprazole or ranitidine in the treatment of reflux esophagitis. Results of a double-blind, randomized, Scandinavian multicenter study. Scand J Gastroenterol. 1988 Jun;23(5):625–632. doi: 10.3109/00365528809093923. [DOI] [PubMed] [Google Scholar]
  30. Strobel C. T., Byrne W. J., Ament M. E., Euler A. R. Correlation of esophageal lengths in children with height: application to the Tuttle test without prior esophageal manometry. J Pediatr. 1979 Jan;94(1):81–84. doi: 10.1016/s0022-3476(79)80361-3. [DOI] [PubMed] [Google Scholar]
  31. Vantrappen G., Rutgeerts L., Schurmans P., Coenegrachts J. L. Omeprazole (40 mg) is superior to ranitidine in short-term treatment of ulcerative reflux esophagitis. Dig Dis Sci. 1988 May;33(5):523–529. doi: 10.1007/BF01798351. [DOI] [PubMed] [Google Scholar]
  32. Zeitoun P., Rampal P., Barbier P., Isal J. P., Eriksson S., Carlsson R. Oméprazole (20 mg/j) comparé à ranitidine (150 mg 2 fois/j) dans le traitement de l'oesophagite par reflux. Résultats d'un essai multicentrique franco-belge, randomisé en double insu. Gastroenterol Clin Biol. 1989 May;13(5):457–462. [PubMed] [Google Scholar]

Articles from Archives of Disease in Childhood are provided here courtesy of BMJ Publishing Group

RESOURCES