Abstract
The aim of this study was to identify dosage regimens using intravenous omeprazole and ranitidine that would elevate and consistently maintain intragastric pH>6 in the first 24 hr of therapy. In 19 healthy, fasting human subjects using continuous 24-hr gastric pH-metry, we studied two dosages of primed infusions of ranitidine (50 mg bolus followed by infusion of either 3 or 6 mg/kg body wt/24 hr) and six regimens of intravenous omeprazole (80–200 mg in 24 hr in two to five boluses). Only the two ranitidine infusions and high doses of omeprazole (≥160 mg/day as four or five boluses) raised the intragastric median pH above 5.4. There was no significant difference in the median intragastric pH after high dose ranitidine and high doses of omeprazole. Considerable interindividual variation in intragastric pH was observed after omeprazole therapy. The percentage of intragastric pH>6.0 during the 24-hr study was lower after omeprazole (35–42%) than after high-dose ranitidine (58%). We conclude that it is possible to raise intragastric pH>6.0 by use of either primed ranitidine infusion or by repeated boluses of omeprazole. However, maintenance of this high pH in the first 24 hr is difficult with both, more so with omeprazole.
Similar content being viewed by others
References
Green FW, Kaplan MM, Curtis LE, Levine PH: Effect of acid and pepsin on blood coagulation and platelet aggregation. Gastroenterology 74:38–43, 1978
Chalmhoff C, Creter D, Djaldetti M: The effect of pH on platelet and coagulation factor activities. Am J Surg 136:257–259, 1978
Berstad A: Antacids, pepsin inhibitors, and gastric cooling in the management of massive upper gastrointestinal haemorrhage. Scand J Gastroenterol 22(suppl 137):33–38, 1987
Low J, Dodds AJ, Biggs JC: Fibrinolytic activity and gastroduodenal secretions—a possible role in upper gastrointestinal haemorrhage. Thromb Res 17:819–830, 1980
Pearson JP, Ward R, Allen A, Roberts NB, Taylor WH: Mucus degradation by pepsin: comparison of mucolytic activity of human pepsin 1 and pepsin 3: Implications in peptic ulceration. Gut 27:243–248, 1986
Patchett SE, Enright H, Afdhal N, O'Connel W, O'Donoghue DP: Clot lysis by gastric juice: Anin vitro study. Gut 30:1704–1747, 1989
Collins R, Langman M: Treatment with histamine H2-antagonists in acute upper gastrointestinal hemorrhage. N Engl J Med 313:660–666, 1985
Walt RP, Cottrell J, Mann SG, Freemantle NP, Langmann MJS: Continuous intravenous famotidine for haemorrhage from peptic ulcer. Lancet 340:1058–1062, 1992
Daneshmend TK, Hawkey CJ, Langman MJS, Logan RFA, Long RG, Walt RP: Omeprazole versus placebo for acute upper gastrointestinal bleeding: Randomised double blind controlled trial. Br Med J 304:143–147, 1992
Santucci L, Fiorucci S, Pelli MA, Calderazzo A, Biasini E, Calderazzo PL, Morelli A: Control of gastric pH with ranitidine in critically ill patients. Dig Dis Sci 36:583–587, 1991
Marchant J, Summers K, McIsaac RL, Wood JR: A comparison of two ranitidine intravenous infusion regimes in critically ill patients. Aliment Pharmacol Ther 2:55–62, 1988
Teyssen S, Scheid J, Fiedler F, Singer MV: Comparison of the effect of two intravenous dosage regimes (dr) of ranitidine (ran) and omeprazole (ome) on 24-hour intragastric (ig) pH in healthy human subjects. Gastroenterology 102:A177, 1992
Teyssen S, Scheid J, Singer MV: Comparison of the effect of intravenous ranitidine, ranitidine and pirenzepine and omeprazole on 24-hour intragastric pH in healthy human subjects. Gastroenterology 104:A210, 1993
Fimmel CJ, Etienne A, Ciluffo T, von Ritter C, Gasser T, Rey JP: Long-term ambulatory gastric pH monitoring: Validation of a new method and effect of H2-antagonists. Gastroenterology 88:1842–1851, 1985
Merki HS: The intragastric long-term pH-metry (Die intragastrale Langzeit pH-Metrie—Methode und klinische Bedeutung). Dtsch Med Wochenschr 113:1443–1445, 1988
Holm SA: A simple sequentially rejective multiple test procedure. Scand J Stat 6:65–70, 1979
Röhmel J, Merki HS, Wilder-Smith CH, Walt RP: Analysis and statistical evaluation of continuous pH recordings. Dig Dis 8(suppl 1):87–96, 1990
Andersen J, Ström M, Naesdal J, Leire K, Walan A: Intravenous omeprazole: Effect of a loading dose on 24-hr intragastric pH. Aliment Pharmacol Ther 4:65–72, 1990
Baak L, Jansen J, Lamers C: Effect of intravenous omeprazole on intragastric pH during intravenous infusion of amino acids. Dig Dis Sci 35:596–602, 1990
Walt RP, Reynolds JR, Langman MJS, Smart HL, Kitchingman G, Somerville KW, Hawkey CJ: Intravenous omeprazole rapidly raises intragastric pH. Gut 25:902–906, 1985
Lind T, Moore M, Olbe L: Intravenous omeprazole: Effect on 24-hour intragastric pH in duodenal ulcer patients. Digestion 34:78–86, 1986
Shamburek RD, Schubert ML: Pharmacology of gastric acid inhibition. Baillere's Clin Gastroenterol 7:23–54, 1993
Cederberg C, Andersson T, Skanberg I: Omeprazole: Pharmacokinetics and metabolism in man. Scand J Gastroenterol 24(suppl 166):33–40, 1989
Sackier JM, Halliday K, Sprott P, Coelho LGV, Batten JJ, Li SK, Sidebotham RL, Baron JH: The effect of intravenous omeprazole on 24h gastric secretion in healthy subjects. Comparisons of continuous and intermittent infusions: A pilot study. Eur J Gastroenterol Hepatol 3:679–684, 1991
Cederberg C, Bergstrand R: Continuous iv infusion of omeprazole effectively controls intragastric pH even during pentagastrin challenge. Gastroenterology 98:A29, 1990
Wilder Smith CH, Gwerder C, Hurlimann S, Merki HS: Dosing requirements during omeprazole infusions diminish with time: individually titrated and constant infusions of omeprazole over 48h. Gastroenterology 104:A223, 1993
Wilder-Smith CH, Merki HS: Antisecretory effects during prolonged infusions of omeprazole and tolerance to ranitidine. Gastroenterology 104:A224, 1993
Ballesteros MA, Hogan DL, Koss MA, Isenberg JI: Bolus or intravenous infusion of ranitidine: effects on gastric pH and acid secretion. A comparison of relative efficacy and cost. Ann Intern Med 112:334–339, 1990
Fiorucci S, Clausi GC, Farinelli M, Santucci L, Pelli MA, Morelli A: Intragastric pH monitoring during antisecretory therapy in patient with gastrointestinal bleeding. Am J Gastroenterol 84:1416–1420, 1989
Wilder-Smith CH, Merki HS: Tolerance during dosing with H2-receptor antagonists. Scand J Gastroenterol 27(suppl 193):14–19, 1992
Teyssen S, Joos A, Singer MV: Tolerance of intragastric acidity occurs within 7 days of a long-term therapy with the H2-receptor antagonist famotidine in healthy human subjects. Gastroenterology 104:A209, 1993
Teyssen S, Chari ST, Joos A, Singer MV: Effects of a 28-day therapy with famotidine on blood levels of alcohol and gastrin and intragastric pH in healthy human subjects. Scand J Gastroenterol 29:398–405, 1994
Author information
Authors and Affiliations
Additional information
Dr. Chari's Fellowship is supported by the Alexander von Humboldt Stiftung, Germany.
Rights and permissions
About this article
Cite this article
Teyssen, S., Chari, S.T., Scheid, J. et al. Effect of repeated boluses of intravenous omeprazole and primed infusions of ranitidine on 24-hour intragastric pH in healthy human subjects. Digest Dis Sci 40, 247–255 (1995). https://doi.org/10.1007/BF02065405
Received:
Revised:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF02065405