An evaluation of intravenous ranitidine vs omeprazole in the 24 h pH measurements in bleeding duodenal ulcer.

Background: The pharmacotherapy of bleeding peptic ulcer is directed to improve the enviroment of the bleeding point by keeping the gastric pH above the proteolitic range for pepsin. Objective: To evaluate the best pharmacological approach to inhibit gastric acid secretion with current antisecretory drugs in patients with bleeding duodenal ulcers. Methods: Forty-seven patients with bleeding duodenal ulcers were randomized to receive I.V.: I) Omeprazole: an initial bolus of 80 mg + perfusion of 3.3 mg/h; II) Omeprazole: an initial bolus of 80 mg + 40 mg/12 h; III) Omeprazole: 40 mg/8 h; nr) Ranitidine: perfusion of 12.5 mg/h; V) Ranitidine: 50 mg/4 h, Gastric acidity was measured and recorded by 24 h gastric pH monitoring. Results: All types of treatment with omeprazole were superior to either continuous perfusion or intermittent bolus of ranitidine in increasing the pH for 24 h and reducing the % of time the gastric pH was below 4 and 6, and the number of time the gastric pH was below 4 for more than 5 min. There were no statistical differences between the different regimens of omeprazole, but continuous perfusion of ranitidine was superior to intermittent ranitidine bolus. Conclusions: Parenteral omeprazole is better than parenteral ranitidine in keeping the intragastric pi-I above the proteolitic range for pepsin in patients with bleeding duodenal ulcers.