Heartburn is commonly seen in patients with gastroesophageal reflux disease (GERD). A study by Khoury et al sought to compare the onset and duration of post-prandial gastric acid suppression with the use of a proton pump inhibitor (PPI) in 10 and 20 mg dose or ranitidine 75 and 150 mg given as single doses in healthy individuals.

The study included 24 healthy volunteers (14 male) with a mean age of 33.4 years (range 18-56 years). In this randomized open label crossover study, the participants received either ranitidine 75 mg or 150 mg or PPI 10 mg or 20 mg when pH returned to <2 after breakfast. There was a washout of at least 2 days between the medications. Gastric pH monitoring was done for 6 h following drug intake. Investigators compared the time between drug ingestion and increase of gastric pH to > 3 and 4, and the total time for which pH remained > 3 and 4 during the 6 h after drug intake, between the study groups.

Study findings –

• The median time needed to pH > 4 was 204.5 min for ranitidine 75 mg, 186 min for ranitidine 150 mg and > 360 min for both doses of PPI (P < 0.001 between the four groups).
• The median time that pH remained > 4 was 93 min for ranitidine 75 mg, 143.5 min for ranitidine 150 mg and 0 min for both PPI 10 and 20 mg (P < 0.001 between the four groups).
• Both doses of ranitidine were found to be significantly superior to PPI doses; however, there was no significant difference between the high and the low doses of either drugs.
• The results were similar for pH > 3.

Ranitidine 75 or 150 mg was associated with faster rise in gastric pH to > 3 and > 4 in comparison with PPI when taken at the end of the post-prandial period. Ranitidine appears to be more effective for the management of episodic post-prandial heartburn.

Source: Khoury RM, Katz PO, Castell DO. Post-prandial ranitidine is superior to post-prandial omeprazole in control of gastric acidity in healthy volunteers. Aliment Pharmacol Ther. 1999 Sep;13(9):1211-4.