Severe reflux disease is commonly encountered in children and can be associated with significant morbidity and fatal events.

A study was designed to compare the effects of omeprazole and high-dose ranitidine in children with gastroesophageal reflux disease (GERD) who were resistant to conventional antisecretory treatment. Researchers assessed the clinical efficacy, the effect on esophagitis and on esophageal and gastric acidity with the two treatment regimens.

Thirty two consecutive patients, with age ranging between 6 months and 13.4 years, having severe reflux esophagitis were randomly allocated for a duration of 8 weeks to receive either standard doses of omeprazole (40 mg/day/1.73 m2 surface area) or high doses of ranitidine (20 mg/kg/day).

A total of 25 patients completed the trial; 12 of them were on omeprazole therapy and 13 were on ranitidine. Patients were subjected to symptomatic score assessment, endoscopic and histological evaluation of the esophagus, and simultaneous esophageal and gastric pH measurement at study initiation and at the end. Results are presented as median (range).

• Both treatments effectively reduced the clinical score, improved histological degree of esophagitis, reduced esophageal acid exposure, measured as minutes of reflux at 24 hour pH monitoring, as well as intragastric acidity, measured as median intragastric pH (Table).
• Serum gastrin concentration was more than 150 ng/l in four patients on omeprazole therapy and in three patients on ranitidine.

In children with refractory reflux esophagitis, high doses of ranitidine appeared to be comparable to omeprazole with regard to healing of esophagitis and relief of symptoms.

Both the therapeutic regimens effectively reduced intragastric acidity as well as intra-esophageal acid exposure.

Table. Changes in study parameters before and after treatment with omeprazole and ranitidine

Source: Cucchiara S, Minella R, Iervolino C, et al. Omeprazole and high dose ranitidine in the treatment of refractory reflux oesophagitis. Archives of Disease in Childhood 1993; 69: 655-659.