Silver et al conducted a randomized, double-blind, placebo-controlled, parallel-group, 12- week, multicenter study among 772 patients with endoscopically confirmed erosive esophagitis. Of the total patients enrolled, 643 (83%) completed the study. Patients were divided into groups and treated with ranitidine 300 mg b.d., ranitidine 150 mg q.d.s. or placebo for up to 12 weeks. Endoscopies were done again after 4, 8 and 12 weeks of treatment.

 Findings:

• Significant higher healing rates of erosive esophagitis were observed with ranitidine 300 mg b.d. compared with placebo at 8 and 12 weeks (P≤ 0.004).
• Significantly fewer heartburn episodes (P<0.021) and lower heartburn severity scores (P< 0.001) were noted with ranitidine compared to placebo.
• The cumulative number of daytime, night-time and total heartburn episodes per week was found to be significantly lower among patients given either dosage of ranitidine compared with placebo (P≤ 0.001).
• The cumulative number of daytime and total heartburn episodes per week was significantly lower with ranitidine 150 mg q.d.s. vs. 300 mg b.d. (P≤ 0.010).
• Fewer antacids were consumed by patients who received either dosage of ranitidine compared with patients receiving placebo (P< 0.001).
• Fewer antacids were consumed by patients receiving ranitidine 150 mg q.d.s. compared with those receiving 300 mg b.d. dosage, and these differences persisted throughout the treatment period (PË‚ 0.001).
• Significantly higher healing rates were achieved with ranitidine 150 mg q.d.s. when compared with placebo at 4, 8 and 12 weeks (37% vs. 21%, 62% vs. 36% and 77% vs. 52%, respectively; PË‚ 0.001)
• Healing rates of erosive oesophagitis at weeks 8 and 12 were significantly higher with ranitidine 300 mg b.d. compared to placebo (51% vs. 36% and 66% vs. 52%, respectively; P< 0.004).
• Both ranitidine regimens were well tolerated and no significant adverse effect was observed.

Erosive oesophagitis healed well with ranitidine 300 mg b.d., which could serve as an appropriate alternative dosage regimen to ranitidine 150 mg q.d.s. in some patients with erosive esophagitis.

Source: Silver MT, Murdock Jr RH, Morrill BB, Sue SO. Ranitidine 300 mg twice daily and 150 mg four-times daily are effective in healing erosive oesophagitis. Aliment Pharmacol Ther 1996;10(3):373–80.