Somatostatin inhibits gastric acid secretion more effectively than pantoprazole in patients with peptic ulcer bleeding: A prospective, randomized, placebo-controlled trial

Objective. Gastric acid inhibition is beneficial in the management of peptic ulcer bleeding ( PUB). The aim of this double-blind study was to test whether somatostatin (SST) increases intragastric pH in PUB as compared with pantoprazole ( PAN) and placebo (PLA). Material and methods. Eligible patients were randomized to receive SST ( 500 mu g/h + 250 mu g bolus), or PAN (8 mg/h + 80 mg bolus) or PLA ( normal saline) i. v., for 24 h. All patients underwent gastric pH monitoring during the infusion of the trial drugs. Results. The three groups ( SST, n = 14; PAN, n = 14; PLA, n = 15) were comparable for age, gender, aetiology of PUB and laboratory data at admission. Mean (+/- SE) baseline pH levels in the fundus increased during the administration of the trial drugs ( SST: 1.94 +/- 0.18 to 6.13 +/- 0.37, p< 0.0001; PAN: 1.93 +/- 0.16 to 5.65 +/- 0.37, p< 0.0001; PLA: 1.86 +/- 0.12 to 2.10 +/- 0.15, p = 0.0917). During the first 12 h of infusion, the mean (+/- SE) percentage time spent above pH 4.0 and 5.4 was higher with SST versus PAN (84.4% +/- 4.8 versus 55.1% +/- 8.3, p = 0.0049 and 74.2% +/- 6.5 versus 47.1% +/- 8.3, p = 0.0163, respectively) and there was a trend favouring the SST group regarding the time spent above pH 6.0 and 6.8 (65.7% +/- 6.4 versus 43.3% +/- 8.2, p = 0.0669 and 49.2% +/- 7.7 versus 28.4 +/- 6.6, p = 0.0738, respectively). Conclusions. In PUB, both SST and PAN inhibit gastric acid secretion as compared with placebo. However, during the first 12 h of the infusion, SST was more effective than PAN in maintaining high intragastric pH. These results may provide a rationale for the administration of SST in PUB.