Effect of ranitidine on intragastric pH and stress-related upper gastrointestinal bleeding in patients with severe head injury

Abstract

We conducted a double-blind, placebo-controlled study to evaluate the effects of ranitidine on intragastric pH and upper gastrointestinal tract bleeding in severe head injury patients. Within 24 hr of the precipitating trauma, 34 adults with Glasgow coma scale scores < or = 10 were randomized to a 6.25 mg/hr ranitidine continuous infusion or placebo for a maximum of 72 hr. Intragastric pH was recorded via an intragastric pH electrode. Patients with hematemesis, hematochezia, bright red blood, or "coffee ground" nasogastric tube aspirates plus a 5% decrease from baseline in hematocrit were considered to have gastrointestinal bleeding. Ranitidine patients maintained a significantly greater mean pH than placebo patients (placebo 2.2, ranitidine 4.1; P < 0.01). All patients had at least two bleeding risk factors at study entry. No ranitidine patients (0/16) developed bleeding compared with five (5/18) placebo patients (P < 0.05). Ranitidine continuous infusion provided consistent intragastric pH control and significant protection from stress-related upper gastrointestinal tract bleeding in a high-risk patient population.

Stress ulcer prophylaxis in the new millennium: A systematic review and meta-analysis

“…No studies were identified that were published in abstract only. The 17 studies included in the meta-analysis enrolled a total of 1836 patients between the years 1980 and 2004 (12,(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40). These studies are summarized in Table 1, and the methodologic quality of the studies is provided in Table 2.…”

Re‐evaluating the Utility of Stress Ulcer Prophylaxis in the Critically Ill Patient: A Clinical Scenario‐Based Meta‐Analysis

“…Figure summarizes the results of the literature search: 34 trials in various languages were included. The main reasons for exclusion were wrong study design, incorrect comparator, and wrong study outcomes.…”

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“…The diversity of opinion is partially explained by methodological problems of the available studies. For example, the incidence of clinically important bleeding is difficult to estimate since many of these studies did not distinguish between various types of occult (microscopic), overt (macroscopic), and clinically important bleeding [9,10,11,12,13,14]. …”