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. 1987 May;28(5):549–556. doi: 10.1136/gut.28.5.549

Does smoking interfere with the effect of histamine H2-receptor antagonists on intragastric acidity in man?

P Bauerfeind, T Cilluffo, C J Fimmel, C Emde, C von Ritter, W Kohler, R Gugler, T Gasser, A L Blum
PMCID: PMC1432885  PMID: 3596336

Abstract

The interaction between smoking and the effect of histamine H2-antagonists on intragastric acidity was examined in a double blind double dummy placebo controlled study. Healthy volunteers, 11 smokers and 10 non-smokers, were given, on four separate days at least one week apart, either placebo or cimetidine 800 mg nocte or ranitidine 2 X 150 mg per day or ranitidine 300 mg nocte. Tablets were taken at 2115 and 0900 h. Smokers smoked a cigarette hourly from 0700 to 2300 h. Breakfast, lunch, and dinner were standardised. Intragastric acidity was measured with a combined intragastric glass electrode and a solid state recorder. The subjects were fully ambulatory. The three histamine H2-receptor antagonist regimens were less effective (p = 0.04) in smokers than in non-smokers, but the difference between acidity of smokers and non-smokers was small. Means of medians of pH during a 24-h period with placebo, cimetidine 800 mg, ranitidine 2 X 150 mg and ranitidine 300 mg were 1.6, 2.3, 3.1, and 2.7 in smokers and 1.5, 2.7, 3.2, and 3.1 in non-smokers, respectively. In a second part of the study seven chronic smokers were reexamined after acutely stopping smoking: inhibition of gastric acidity by histamine H2-receptor antagonists was similar before and after withdrawal. Smoking does not affect intragastric acidity in untreated volunteers and only slightly decreases the effectiveness of histamine H2-receptor antagonists on intragastric acidity. This effect best in part explains the unfavourable effect of smoking on healing of peptic ulcer in patients treated with these drugs.

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Selected References

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  1. Achord J. L. Gastric pepsin and acid secretion in patients with acute and healed duodenal ulcer. Gastroenterology. 1981 Jul;81(1):15–18. [PubMed] [Google Scholar]
  2. Adami H. O., Björklund O., Enander L. K., Gustavsson S., Löf L., Nordahl A., Rosén A. Cimetidine or propantheline combined with antacid therapy for short-term treatment of duodenal ulcer. Dig Dis Sci. 1982 May;27(5):388–393. doi: 10.1007/BF01295645. [DOI] [PubMed] [Google Scholar]
  3. Aenishänslin W., Bergoz R., Capitaine Y., Egger G., Etienne A., Fumagalli I., Güller R., Hammer B., Kobler E., Leuthold E. Ranitidintherapie des Ulcus duodeni: Vergleich der zweimaligen und der einmaligen Applikation. Eine multizentrische Schweizer Doppeltblindstudie. Schweiz Med Wochenschr. 1986 May 10;116(19):637–641. [PubMed] [Google Scholar]
  4. Aenishänslin W., Bärlocher C., Bernoulli R., Egger G., Eisner M., Fumagalli I., Güller R., Leuthold E., Osterkorn K., Pelloni S. Misoprostol und Cimetidin bei der Behandlung des Ulcus duodeni. Eine multizentrische Schweizer Doppeltblindstudie. Schweiz Med Wochenschr. 1985 Sep 7;115(36):1225–1231. [PubMed] [Google Scholar]
  5. Barakat M. H., Menon K. N., Badawi A. R. Cigarette smoking and duodenal ulcer healing. An endoscopic study of 197 patients. Digestion. 1984;29(2):85–90. doi: 10.1159/000199014. [DOI] [PubMed] [Google Scholar]
  6. Barr G. D., Paris C. H., Middleton W. R., Piper D. W. Comparison of ranitidine and cimetidine in duodenal ulcer healing. Med J Aust. 1982 Jul 24;2(2):83–85. doi: 10.5694/j.1326-5377.1982.tb124235.x. [DOI] [PubMed] [Google Scholar]
  7. Bauerfeind P., Cilluffo T., Fimmel C. J., Gasser T., Köhler W., Merki H., Emde C., Etienne A., Blum A. L. Die intragastrale Langzeit-pH-Metrie. Schweiz Med Wochenschr. 1985 Nov 16;115(46):1630–1641. [PubMed] [Google Scholar]
  8. Bianchi Porro G., Prada A., Petrillo M., Lazzaroni M. Gastric acid secretion, smoke and duodenal ulcer healing. Gastroenterology. 1982 Feb;82(2):394–395. [PubMed] [Google Scholar]
  9. Bochenek W. J., Koronczewski R. Effects of cigarette smoking on bicarbonate and volume of duodenal contents. Am J Dig Dis. 1973 Sep;18(9):729–733. doi: 10.1007/BF01070841. [DOI] [PubMed] [Google Scholar]
  10. Boyd E. J., Wilson J. A., Wormsley K. G. Smoking impairs therapeutic gastric inhibition. Lancet. 1983 Jan 15;1(8316):95–97. doi: 10.1016/s0140-6736(83)91742-7. [DOI] [PubMed] [Google Scholar]
  11. Brown P. The influence of smoking on pancreatic function in man. Med J Aust. 1976 Aug 21;2(8):290–293. doi: 10.5694/j.1326-5377.1976.tb130184.x. [DOI] [PubMed] [Google Scholar]
  12. Bynum T. E., Solomon T. E., Johnson L. R., Jacobson E. D. Inhibition of pancreatic secretion in man by cigarette smoking. Gut. 1972 May;13(5):361–365. doi: 10.1136/gut.13.5.361. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. COOPER P., KNIGHT J. B., Jr Effect of cigarette smoking on gastric secretions of patients with duodenal ulcer. N Engl J Med. 1956 Jul 5;255(1):17–21. doi: 10.1056/NEJM195607052550103. [DOI] [PubMed] [Google Scholar]
  14. Classen M., Dammann H. G., Domschke W., Hengels K. J., Hüttemann W., Londong W., Rehner M., Simon B., Witzel L., Berger J. Kurzzeit-Therapie des Ulcus duodeni mit Omeprazol und Ranitidin. Ergebnisse einer deutschen Multizenterstudie. Dtsch Med Wochenschr. 1985 Feb 8;110(6):210–215. doi: 10.1055/s-2008-1068800. [DOI] [PubMed] [Google Scholar]
  15. Classen M., Dammann H. G., Domschke W., Hüttemann W., Londong W., Rehner M., Scholten T., Simon B., Witzel L., Berger J. Abheilungsraten nach Omeprazol- und Ranitidin-Behandlung des Ulcus ventriculi. Ergebnisse einer deutschen Multizenterstudie. Dtsch Med Wochenschr. 1985 Apr 19;110(16):628–633. doi: 10.1055/s-2008-1068876. [DOI] [PubMed] [Google Scholar]
  16. Dammann H. G., Rehner M., Gottlieb W. R., Walter T. A., Müller P., Simon B. Säuresekretionshemmung bei Rauchern durch den neuen Imidazol-H2-Rezeptorantagonisten Etintidin. Dtsch Med Wochenschr. 1985 May 3;110(18):739–740. [PubMed] [Google Scholar]
  17. Debas H. T., Cohen M. M., Holubitsky I. B., Harrison R. C. Effect of cigarette smoking on human gastric secretory responses. Gut. 1971 Feb;12(2):93–96. doi: 10.1136/gut.12.2.93. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. 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]
  19. Fung W. P., Mahoney D. P., Beilin L. J. Effect of cigarette smoking on gastric secretion of 6-keto prostaglandin F1 alpha. Aust N Z J Med. 1982 Apr;12(2):206–208. doi: 10.1111/j.1445-5994.1982.tb02461.x. [DOI] [PubMed] [Google Scholar]
  20. Fung W. P., Tye C. Y. Effect of smoking on gastric acid secretion. Aust N Z J Med. 1973 Jun;3(3):251–254. doi: 10.1111/j.1445-5994.1973.tb03090.x. [DOI] [PubMed] [Google Scholar]
  21. Grimes D. S., Goddard J. Effect of cigarette smoking on gastric emptying. Br Med J. 1978 Aug 12;2(6135):460–461. doi: 10.1136/bmj.2.6135.460. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Gugler R., Rohner H. G., Kratochvil P., Brandstätter G., Schmitz H. Effect of smoking on duodenal ulcer healing with cimetidine and oxmetidine. Gut. 1982 Oct;23(10):866–871. doi: 10.1136/gut.23.10.866. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Hetzel D. J., Korman M. G., Hansky J., Shearman D. J., Eaves E. R., Schmidt G. T., Hecker R., Fitch R. J. The influence of smoking on the healing of duodenal ulcer treated with oxmetidine or cimetidine. Aust N Z J Med. 1983 Dec;13(6):587–590. doi: 10.1111/j.1445-5994.1983.tb02609.x. [DOI] [PubMed] [Google Scholar]
  24. Ireland A., Colin-Jones D. G., Gear P., Golding P. L., Ramage J. K., Williams J. G., Leicester R. J., Smith C. L., Ross G., Bamforth J. Ranitidine 150 mg twice daily vs 300 mg nightly in treatment of duodenal ulcers. Lancet. 1984 Aug 4;2(8397):274–276. doi: 10.1016/s0140-6736(84)90312-x. [DOI] [PubMed] [Google Scholar]
  25. Isaac P. F., Rand M. J. Cigarette smoking and plasma levels of nicotine. Nature. 1972 Apr 7;236(5345):308–310. doi: 10.1038/236308a0. [DOI] [PubMed] [Google Scholar]
  26. Jusko W. J. Role of tobacco smoking in pharmacokinetics. J Pharmacokinet Biopharm. 1978 Feb;6(1):7–39. doi: 10.1007/BF01066061. [DOI] [PubMed] [Google Scholar]
  27. Kang J. Y., Piper D. W. Cimetidine and colloidal bismuth in treatment of chronic duodenal ulcer. Comparison of initial healing and recurrence after healing. Digestion. 1982;23(2):73–79. doi: 10.1159/000198690. [DOI] [PubMed] [Google Scholar]
  28. Kellow J. E., Barr G. D., Cowen A. E., Ward M., Wood L., Piper D. W. Comparison of ranitidine and cimetidine in the treatment of chronic gastric ulcer. A double-blind trial. Digestion. 1983;27(2):105–110. doi: 10.1159/000198938. [DOI] [PubMed] [Google Scholar]
  29. Korman M. G., Hansky J., Eaves E. R., Schmidt G. T. Influence of cigarette smoking on healing and relapse in duodenal ulcer disease. Gastroenterology. 1983 Oct;85(4):871–874. [PubMed] [Google Scholar]
  30. Lam S. K., Koo J. Accurate prediction of duodenal-ulcer healing rate by discriminant analysis. Gastroenterology. 1983 Aug;85(2):403–412. [PubMed] [Google Scholar]
  31. Lee F. I., Fielding J. D., Costello F. T. Ranitidine compared with cimetidine in the short-term healing of duodenal ulcer. Postgrad Med J. 1983 Feb;59(688):88–92. doi: 10.1136/pgmj.59.688.88. [DOI] [PMC free article] [PubMed] [Google Scholar]
  32. Mahachai V., Walker K., Thomson A. B., Zuk L., Kirdeikis P., Fisher D., Brunet K. Comparison of cimetidine and ranitidine on 24-hour intragastric acidity and serum gastrin profile in patients with esophagitis. Dig Dis Sci. 1985 Apr;30(4):321–328. doi: 10.1007/BF01403840. [DOI] [PubMed] [Google Scholar]
  33. Manousos O. N., Zografos A., Nicolaou A., Scandalis N., Kalogerakou-Ioannidi E. A double-blind study of cimetidine in patients with duodenal or gastric ulcer in Greece. J Int Med Res. 1978;6(5):381–383. doi: 10.1177/030006057800600505. [DOI] [PubMed] [Google Scholar]
  34. Massarrat S., Enschai F., Pittner P. M. Increased gastric secretory capacity in smokers without gastrointestinal lesions. Gut. 1986 Apr;27(4):433–439. doi: 10.1136/gut.27.4.433. [DOI] [PMC free article] [PubMed] [Google Scholar]
  35. McCloy R. F., Greenberg G. R., Baron J. H. Duodenal pH in health and duodenal ulcer disease: effect of a meal, Coca-Cola, smoking, and cimetidine. Gut. 1984 Apr;25(4):386–392. doi: 10.1136/gut.25.4.386. [DOI] [PMC free article] [PubMed] [Google Scholar]
  36. Moshal M. G., Spitaels J. M., Khan F., Mason J., Naidoo V., Schlemmer L. Factors affecting duodenal ulcer healing. Four double-blind trials in 193 patients. S Afr Med J. 1982 Feb 6;61(6):202–206. [PubMed] [Google Scholar]
  37. Murthy S. N., Dinoso V. P., Jr, Clearfield H. R., Chey W. Y. Serial pH changes in the duodenal bulb during smoking. Gastroenterology. 1978 Jul;75(1):1–4. [PubMed] [Google Scholar]
  38. Murthy S. N., Dinoso V. P., Jr, Clearfield H. R., Chey W. Y. Simultaneous measurement of basal pancreatic, gastric acid secretion, plasma gastrin, and secretin during smoking. Gastroenterology. 1977 Oct;73(4 Pt 1):758–761. [PubMed] [Google Scholar]
  39. Müller-Lissner S. A. Bile reflux is increased in cigarette smokers. Gastroenterology. 1986 May;90(5 Pt 1):1205–1209. doi: 10.1016/0016-5085(86)90386-0. [DOI] [PubMed] [Google Scholar]
  40. Nagata M., Okuma Y., Osumi Y. Effects of intracerebroventricularly applied nicotine on enhanced gastric acid secretion and mucosal blood flow in rats. Eur J Pharmacol. 1984 Jun 1;101(3-4):185–191. doi: 10.1016/0014-2999(84)90155-9. [DOI] [PubMed] [Google Scholar]
  41. Novis B. H., Marks I. N., Bank S., Sloan A. W. The relation between gastric acid secretion and body habitus, blood groups, smoking, and the subsequent development of dyspepsia and duodenal ulcer. Gut. 1973 Feb;14(2):107–112. doi: 10.1136/gut.14.2.107. [DOI] [PMC free article] [PubMed] [Google Scholar]
  42. Randolph W. C., Osborne V. L., Walkenstein S. S., Intoccia A. P. High-pressure liquid chromatographic analysis of cimetidine, a histamine H2-receptor antagonist, in blood and urine. J Pharm Sci. 1977 Aug;66(8):1148–1150. doi: 10.1002/jps.2600660825. [DOI] [PubMed] [Google Scholar]
  43. STEIGMANN F., DOLEHIDE R. H., KAMINSKI L. Effects of smoking tobacco on gastric acidity and motility of hospital controls and patients with peptic ulcer. Am J Gastroenterol. 1954 Nov;22(5):399–409. [PubMed] [Google Scholar]
  44. Sonnenberg A., Hüsmert N. Effect of nicotine on gastric mucosal blood flow and acid secretion. Gut. 1982 Jun;23(6):532–535. doi: 10.1136/gut.23.6.532. [DOI] [PMC free article] [PubMed] [Google Scholar]
  45. Sonnenberg A., Müller-Lissner S. A., Vogel E., Schmid P., Gonvers J. J., Peter P., Strohmeyer G., Blum A. L. Predictors of duodenal ulcer healing and relapse. Gastroenterology. 1981 Dec;81(6):1061–1067. [PubMed] [Google Scholar]
  46. Whitecross D. P., Clarke A. D., Piper D. W. The effect of cigarette smoking on human gastric secretion. Scand J Gastroenterol. 1974;9(4):399–403. [PubMed] [Google Scholar]
  47. Wilkinson A. R., Johnston D. Inhibitory effect of cigarette smoking on gastric secretion stimulated by pentagastrin in man. Lancet. 1971 Sep 18;2(7725):628–632. doi: 10.1016/s0140-6736(71)80070-3. [DOI] [PubMed] [Google Scholar]

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