Effect of ranitidine gastroduodenal mucosal damage induced by nonsteroidal antiinflammatory drugs

Abstract

The effect of ranitidine in preventing mucosal damage caused by nonsteroidal antiinflammatory drugs (NSAIDs) was evaluated for eight weeks in a prospective study of 144 patients requiring NSAIDs. Patients with normal endoscopic findings were randomly assigned to receive either ranitidine 150 mg twice daily or placebo for eight weeks, along with either ibuprofen, indomethacin, naproxen, sulindac, or piroxicam. Duodenal damage was significantly less in the ranitidine group compared with the placebo group by weeks 4 and 8 (P less than or equal to 0.01). Duodenal ulcers did not develop in any patients on ranitidine (0/57) compared with 4/49 patients (8%) on placebo (P = 0.02). No significant difference was found between treatment groups with respect to gastric damage; 6/60 (10%) in the ranitidine group compared with 6/50 (12%) in the placebo group developed gastric ulcers. These findings suggest that acid suppression is of greater importance for mucosal protection in the duodenum than in the stomach, where other defense mechanisms may be operative. While ranitidine is an effective prophylaxis for NSAID-induced damage in the duodenum, further studies are needed to define specific risk groups and to assess the potential usefulness of more complete acid suppression in preventing gastric mucosal damage.

A comparison of the cost-effectiveness of five strategies for the prevention of non-steroidal anti-inflammatory drug-induced gastrointestinal toxicity: a systematic review with economic modelling

“…Two studies did not state what type of arthritis its participants had. 46,49 The mean duration of arthritis in these studies varied from 0 years (where all participants were newly diagnosed 53 ) to 22 years. 56 Duration of arthritis was not stated in nine trials.…”

“…The mean age of participants ranged from 43 49 to 67 56 years old. Mean age was not stated in three studies.…”

“…Three studies recruited participants with Lanza scores of zero (undamaged GI surfaces). 48,49,57 One study only recruited patients with normal gastric mucosa. 46 One study recruited people with no more than one or two erosions or haemorrhages.…”

“…45,47,49,[55][56][57][58] There was a suggestion of such funding in a further three studies (in Swift and colleagues 50 Glaxo provided the placebo, in Ehsanullah and colleagues 48 Glaxo generated the randomisation sequence and the contact author worked for Glaxo, in Simon and colleagues 54 the affiliation of the contact author was Merck). Funding was not mentioned in four studies.…”

“…Compliance was assessed in nine studies, 45,48,49,51,53,55,57,58 but only two studies reported the results of this assessment in both arms (Taha and colleagues 55 stated that 12 of 93 in the placebo arm and 11 of 95 and 14 of 97 in the active arms, had 'poor compliance', and Rugstad and colleagues 53 reported that 92% in the placebo group and 94% in the active cimetidine arm took at least 70% of the study medication.…”