Ranitidine in the treatment of duodenal ulcer disease: relationship between antisecretory effect and ulcer healing rate

Inadequate response to H2-receptor antagonists. Absence of parietal cell cAMP-stimulating autoantibodies

In peptic ulcer patients with adequate (AR; N = 16) and inadequate response (IR; N = 20) to H2-receptor antagonists, the presence of parietal cell cAMP-stimulating autoantibodies was studied. Serum Ig fractions from these patients and 10 control subjects were examined to test whether they could stimulate cAMP production in a gastric cell line model. The human cell line HGT-1 was found to be a sensitive in vitro model for the cAMP stimulation assay as histamine (10 microM) increased by 11-fold the production of cAMP. Neither IgG (4 mg/ml) nor IgG-free Ig fractions (1 mg/ml) isolated from the blood of AR or IR affected cAMP production in the HGT-1 cells. The results obtained with the cAMP stimulation assay were confirmed by indirect immunofluorescence measurements based on frozen sections of rat stomach and kidney. No specific staining of rat parietal cells could be observed with patient sera. In addition, human gastric biopsies of the oxyntic mucosa from the same patients were studied for immunoreactive cell populations to assess organ-specific autoimmune processes. Biopsy specimens from AR and IR showed increased lymphocytic infiltrates, usually associated with gastritis. However, no significant differences in location of various cell populations between AR and IR could be observed. Our findings do not support a recent hypothesis that poor response to treatment with H2-receptor antagonists is due to the presence of autoantibodies.

Pain and quality of life in patients with acute duodenal ulcer treated with ranitidine

BACKGROUND

The various components of pain and quality of life in duodenal ulcer patients receiving antisecretory drugs have not been studied to date.

METHODS

Ninety-five patients with epigastric pain and duodenal ulcer at endoscopy completed this prospective, multicenter, open-study. All were treated with effervescent ranitidine 300 mg daily for 4 weeks. The following parameters were assessed: (a) disappearance of duodenal ulcer pain by self-evaluation and on a weekly visual analogue scale (VAS) from 0 to 100; (b) evolution of sensory and affective components of ulcer pain by the Validated French Version of the McGill Pain Questionnaire (Questionnaire Douleur de Saint-Antoine, QDSA); (c) quality of life by the Nottingham Health Profile (NHP) which includes six criteria: pain, mobility, energy, emotions, sleep and social isolation.

RESULTS

Forty-nine, 66 and 87% of the patients were pain-free during the day-time after 7, 14 and 28 days, respectively. Corresponding figures for the night-time were 80%, 88% and 97% respectively. Median time to disappearance of ulcer pain was 8 days. VAS self-assessment showed a significant decrease each week throughout the treatment period (P = 0.001). Sensory and affective QDSA scores were significantly improved after the second day and at each assessment during the 28 days of treatment (P = 0.001). Physical as well as affective aspects of quality of life were significantly improved after 28 days for each of the six criteria explored (P = 0.001). The duodenal ulcer healing rate was 86% after 4 weeks of treatment.

CONCLUSIONS

Using complementary scales measuring different aspects of ulcer pain, sensory and affective components improved significantly from the second day of treatment with ranitidine 300 mg. A significant improvement in quality of life is observed after a 4-week treatment. QDSA and NHP appear to be useful evaluation tools of duodenal ulcer pain and quality of life.

Pantoprazole and ranitidine in the treatment of acute duodenal ulcer. A multicentre study

BACKGROUND

Pantoprazole is a new substituted benzimidazole that inhibits the parietal cell H+,K(+)-adenosine triphosphatase.

METHODS

Pantoprazole (40 mg) was compared with ranitidine (300 mg) in the treatment of acute duodenal ulcer. Two hundred and sixty-six patients with endoscopically diagnosed duodenal ulcers entered this multicentre, double-blind study. The primary efficacy variable was complete ulcer healing at 2 weeks; treatment then continued for a further 2 weeks if ulcers were unhealed.

RESULTS

After 2 weeks 112 of 164 (68%) patients in the pantoprazole group had healed ulcers, compared with 36 of 81 (44%) taking ranitidine (p < 0.001). After 4 weeks the cumulative healing rates were 96% and 85% (p < 0.01). Improvement in ulcer pain was also significantly better with pantoprazole than with ranitidine (81% versus 62% with no pain at 2 weeks, p < 0.01).

CONCLUSIONS

Pantoprazole is clinically superior to ranitidine in the treatment of acute duodenal ulcer, in terms of both healing and symptom relief.

A dose-ranging study of ranitidine and its effect on intragastric and intra-oesophageal acidity in subjects with gastro-oesophageal reflux disease

METHODS

This randomized, double-blind, single-centre, crossover study was designed to assess the effects of three regimens of ranitidine (150 mg b.d., 300 mg b.d. and 300 mg q.d.s.) and placebo on intra-oesophageal and intragastric pH in subjects with gastro-oesophageal reflux disease (GERD). Twenty-six subjects were screened, and 9 were evaluable by the admission criteria. These 9 subjects received each of the regimens for 72 h, and a wash-out period of at least 48 h followed each dosing period. Standard meals and beverages were provided.

RESULTS

With increasing doses of ranitidine, 24-h intragastric mean H+ and integrated H+ fell, and the percentage of the time the pH was equal to or greater than 4 (% time pH > or = 4) rose: the minimum effective dose for these effects was ranitidine 300 mg daily. With increasing doses of ranitidine there was also a progressive decline in mean 24-h intra-oesophageal H+ and integrated H+, and increasing % time pH > or = 4. The minimal effective dose was 300 mg daily for intra-oesophageal mean H+ and integrated H+, and 600 mg for % time pH > or = 4. The minimal effective dose to decrease the number of reflex episodes was 1200 mg ranitidine. For the daytime upright position, a dose effect of increasing ranitidine was also seen, with minimal effective ranitidine doses of 300 mg for a decrease in mean H+, and 1200 mg for % time pH > or = 4.

CONCLUSION

If these higher doses of ranitidine are confirmed to be more effective than the standard 150 mg b.d. regimen for the treatment of patients with gastro-oesophageal reflux disease, then the mechanism of this action probably relates to the lower exposure of the oesophageal mucosa to acid.

Effects of ranitidine 150 mg four times a day on 24-hour intragastric acidity and 24-hour plasma gastrin concentration

Twenty-four-hour integrated intragastric acidity and 24-hr integrated plasma gastrin concentration was measured twice in 23 healthy male volunteers on the seventh day of oral dosing with placebo or ranitidine 150 mg four times a day. The study was a randomized, double-blind, placebo-controlled, two-way crossover investigation. The mean integrated 24-hr intragastric acidity during dosing with ranitidine 150 mg four times a day decreased to 32% of the placebo value (placebo 825 mmol/hr/liter; ranitidine 265 mmol/hr/liter). The mean integrated 24-hr plasma gastrin concentration during dosing with ranitidine 150 mg four times a day was 904 pmol/hr/liter compared with placebo (410 pmol/hr/liter)--an increase of 122%. The median number of hours of pH > 3 during dosing with placebo and with ranitidine 150 mg four times a day were 5 and 11 hr, respectively. Ranitidine 150 mg four times a day caused a significant decrease of mean integrated intragastric acidity for each meal-related interval and also during the night.

Early evening dosing of ranitidine. Comparison with nighttime dosing of ranitidine or cimetidine in duodenal ulceration

A double-blind multinational comparison of ranitidine 300 mg post evening meal (pem), ranitidine 300 mg nocte and cimetidine 800 mg nocte has been carried out in 1677 patients with endoscopically verified duodenal ulcer disease. Fifty-three percent of ulers healed by two weeks during treatment with ranitidine 300 mg pem and 88% by four weeks, while the results for ranitidine 300 mg nocte were 50% and 86%, respectively, and 44% and 84% for cimetidine. The difference between ranitidine 300 mg pem and cimetidine was significant at two weeks (P = 0.002, Mantel-Haenszel chi-squared test). The relative efficacy of the treatments was not dependent upon gender, smoking habit, alcohol intake, or ulcer frequency. However, the overall differences in healing between patients with small and large ulcers and patients with single and multiple ulcers were significantly different at weeks 2 and 4 (P < 0.001). Significantly more patients treated with ranitidine (60%) had complete relief of epigastric pain than those treated with cimetidine (54%) (P < 0.05). A meta-analysis of the four double-blind comparisons of ranitidine 300 mg pem (N = 841) and 300 mg nocte (N = 849), including the present study, failed to show the benefits of pem dosing, predicted from pharmacological studies.

The effects of 300 mg ranitidine at night, twice daily and four times daily on intragastric acidity in normal subjects

The aim of this study was to compare to placebo the effects of 300 mg ranitidine nocte, b.d. and q.d. on intragastric acidity. The study was performed on healthy male subjects and intragastric acidity measured by radiotelemetry. All active treatments significantly decreased 24-hr acidity, with a median suppression of 61.0% with 300 mg ranitidine nocte, 77.7% with 300 mg b.d. and 78.0% with 300 mg q.d.s. There was no significant difference between the effects of two higher dose regimens; although the 300 mg q.d.s. suppressed daytime acidity more than 300 mg b.d. (88.9% vs. 77.8%), it suppressed nocturnal acidity less effectively (65.5%) than either 300 mg nocte (92.9%) or 300 mg b.d. (90.0%). These data suggest that only modest additional therapeutic acid inhibition can be achieved by increasing the dose of ranitidine above 600 mg daily.