Long-term use of non-steroidal anti-inflammatory drugs (
NSAIDs) increases the risk of serious gastroduodenal events. To minimise these risks, patients often require concomitant
acid-suppressive
therapy. We conducted a literature review of clinical trials examining use of
ranitidine 150 mg twice daily to heal
gastroduodenal ulcers (GU) in
NSAID recipients. Seven studies were identified. After 8 weeks' treatment with
ranitidine, GU healing rates ranged from 50% to 74% and rates of
duodenal ulcer (DU) healing ranged from 81% to 84%.
Ranitidine was more effective when
NSAIDs were discontinued (healing rates reaching 95% and 100%, respectively). The
ulcer healing rate with
sucralfate was similar to that of
ranitidine. However,
proton pump inhibitor (PPI)
therapy was associated with significantly greater rates of both GU and DU healing than
ranitidine; 8-week GU rates were 92% and 88% with
esomeprazole 40 mg and 20 mg, respectively (vs. 74% with
ranitidine, p < 0.01). For
omeprazole, 8-week healing rates were 87% with
omeprazole 40 mg and 84% with
omeprazole 20 mg (vs. 64% for
ranitidine, p < 0.001), and for
lansoprazole the corresponding values were 73-74% and 66-69% for the 30 mg and 15 mg doses, respectively (vs. 50-53% for
ranitidine, p < 0.05). In the PPI study reporting DU healing the values were 92% for
omeprazole 20 mg (vs. 81% for
ranitidine, p < 0.05) and 88% for
omeprazole 40 mg (p = 0.17 vs.
ranitidine).
NSAID-associated GU are more likely to heal when patients receive concomitant treatment with a PPI rather than
ranitidine.