A study was conducted to look into the relationship between gastric acidity suppression by anti-secretory drugs and the esophagitis healing rates. The study also assessed if increasing the dose of the ranitidine also increases basal and meal-stimulated serum gastrin concentrations. The investigators compared the gastrin concentrations with those obtained after 2 weeks of PPI administration in the same patients.

Information on suppression of intragastric acidity was obtained from a review of published trials of antisecretory drugs in ulcer patients. 24-h acidity was considered as an independent variable and corresponding esophagitis healing rates as a dependent variable. The correlation between the two variables was explored. After 8 weeks of treatment, there was a significant correlation between healing rates and suppression of 24-h acidity.

Additionally, four 2-week study periods were performed randomly in 8 reflux esophagitis patients, wherein the patients were administered placebo, 300 mg ranitidine twice a day, 300 mg ranitidine four times a day, or 20 mg PPI once daily.

A gradual reduction was noted in the percentage of time that intraesophageal pH was less than 4 with increasing doses of ranitidine in comparison with the placebo study.

In these 8 patients, 2-week treatment with 300 mg ranitidine twice a day and 300 mg four times a day led to progressive reduction in 24-h intraesophageal acidity while only moderately increasing basal and meal-stimulated serum gastrin concentrations, which were significantly below the values obtained after a 2-week treatment course with the PPI.

The study thus revealed that high doses of ranitidine may serve as a potential alternative in patients with erosive or ulcerative reflux esophagitis. These higher doses of H2-receptor antagonists lead to a significant improvement in healing rates and cause only moderate rise in serum gastrin levels.

Source: Jansen JB, Lamers CB. High Doses of Ranitidine in Patients with Reflux Oesophagitis. Scand J Gastroenterol Suppl. 1990;178:42-6.