GERD		Ranitidine
Acid Reflux; Gastroesophageal Reflux; Gastroesophageal Reflux (GERD); Gastroesophageal Reflux Disease; Gastroesophageal ...		Zantac; Zantac 75

Pictures

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Ranitidine 300 mg PAR yellow oval film coated

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Ranitidine 150 mg APO white round film coated

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Ranitidine 300 mg GG orange round

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Common uses This medicine is a histamine blocker used to treat and prevent ulcers It is also used to treat gastroesophageal reflux disease gerd This medicine

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over 2 years with omeprazole but not with ranitidine again because the acid wasn t well controlled There are many questions continuing about the treatment of GERD and its complications Slide 13 CagA Positive H pylori and GERD Just to remind you of the relationship of Helicobacter pylori to reflux disease and its severity This paper from the Cleveland Clinic 3 years ago

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Print This Article Zantac Ranitidine Common uses This medicine is a histamine blocker used to treat and prevent ulcers It is also used to treat gastroesophageal reflux disease gerd This medicine may also

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the third day Proton pump inhibitors given intravenously are much more successful in maintaining a neutral pH in the stomach and this neutrality has been maintained in the subsequent days Slide Injection or Infusion Slide Injection or Infusion What about different modes of giving the drug Should we give it as bolus injection or infusion This study looked at ranitidine and

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an ITT analysis but also a per protocol analysis and I will only present data from the ITT They also had a follow up of 92 so this trial fulfilled all the criteria for a valid trial Slide 11 Rabeprazole vs Ranitidine Healing of Esophagitis ITT Let s look at the results At 4 weeks healing rates of rabeprazole were statistically significantly different and better than

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patients think if they pop that PPI I keep it by my bedside I pop it I m going to get immediate symptom relief and that s not at all the case It s dependent on the pump and the AUC Slide Postprandial Acid Suppression Ranitidine vs Omeprazole If we look at one example of a study assessing this this was done in healthy volunteers and they looked at the onset to achieve

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for proton pump inhibitors in different ethnic groups Maybe Asians require less PPI therefore even oral dose of omeprazole was sufficient to suppress secretion of acid in the stomach Slide IV H2RA vs IV PPI for 3 Days This is the study that looked at ranitidine compared to omeprazole and placebo and tried to determine how much of this drug is required to keep the

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inhibitors given intravenously are much more successful in maintaining a neutral pH in the stomach and this neutrality has been maintained in the subsequent days Slide Injection or Infusion Slide Injection or Infusion What about different modes of giving the drug Should we give it as bolus injection or infusion This study looked at ranitidine and omeprazole given in the two

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by which it was compared was ranitidine the leader for H2RAs As 4 newer PPIs have been introduced each of them has comparator data to omeprazole which has been the gold standard Slide 11 Effects of Rabeprazole vs Omeprazole 24 Hr Intragastric Acidity Here is a very interesting study done by Williams et al They recruited 24 healthy volunteers who were Helicobacter

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clinically significant Not only are these differences statistically significant but if you convert them and look at numbers needed to treat they also seem to be clinically significant Slide 12 Rabeprazole vs Ranitidine Daytime Symptom Relief ITT If you look at the same type of analysis with symptoms and I only show daytime symptom relief nighttime symptom relief is

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Slide 17 Omeprazole More Effective Than Ranitidine in Controlling Symptoms of Erosive Esophagitis There is no tolerance with PPIs In a 1 year long term maintenance therapy trial

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in the United States we have cimetidine ranitidine famotidine and nizatidine If we look at PPIs we have omeprazole lansoprazole rabeprazole pantoprazole and esomeprazole Slide 10 Gold Standard Treatment of Gastroesophageal Reflux Disease When each one of these was introduced there was a different standard for comparison For example when cimetidine was

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of ranitidine at bedtime to control their gastric breakthrough Linear regression of Barrett s in all 9 of them Two of them with short segment Barrett s Five of 9 had squamous islands Slide 12 Relative Changes in Length and Surface Area of Barrett s Esophagus More importantly this observation from the Netherlands by Peters et al where they randomized approximately 50

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in 1997 in Gastroenterology and this was a meta analysis of 43 trials of which 93 were randomized controlled trials Both of these are valid given the rules and the guidelines of EBM Slide 14 Healing of Esophagitis The first one from Caro et al showed that rabeprazole omeprazole lansoprazole and pantoprazole when compared to ranitidine were statistically

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Interestingly this was ranitidine 150 mg 4 times a day not the typical twice a day dose that we would use This was a large study 338 patients of which 231 were male and 107 were female Slide 10 EBM Approach to Therapy Article If we go back to the guidelines and criteria that I showed you earlier I want to use those to determine whether this trial was valid It was

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In two U S multicenter double blind ranitidine controlled studies of 925 total patients with frequent GERD symptoms but no esophageal erosions by endoscopy lansoprazole 15

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