Comparison of Omeprazole and Ranitidine for Stress Ulcer Prophylaxis

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.