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NSAID-Induced Ulcers: Omeprazole vs. Ranitidine.

Ideally, nonsteroidal antiinflammatory drugs (NSAIDs) would be stopped when gastroduodenal side effects occur, but many patients depend on these drugs. This randomized trial compared omeprazole (20 mg or 40 mg daily) and ranitidine (150 mg twice a day) in 541 patients who had endoscopically diagnosed gastroduodenal ulcers or erosions while taking NSAIDs, and who needed ongoing NSAID therapy (usually for arthritis). Most patients had dyspeptic symptoms.

At eight weeks, the rate of success (defined as ulcer healing, fewer than five erosions, and no more than mild dyspepsia) was significantly higher with omeprazole than ranitidine (80 percent vs. 63 percent). The 20 mg dose of omeprazole was as good as the 40 mg dose. Omeprazole was superior to ranitidine for all types of lesions (gastric ulcer, duodenal ulcer, and erosions).

In a second phase of the study, those responding in the first phase were randomized to maintenance therapy with omeprazole or ranitidine. At six months, the rate of continued remission was significantly higher with omeprazole than with ranitidine (72 percent vs. 59 percent).

Comment: Omeprazole appears superior to ranitidine for treatment and prevention of NSAID-induced ulceration. Because omeprazole is a more potent inhibitor of acid secretion, these findings support the idea that acid plays a role in NSAID-related ulcers.

— AS Brett

Published in Journal Watch General Medicine March 17, 1998

Citation(s):

Yeomans ND et al. A comparison of omeprazole with ranitidine for ulcers associated with nonsteroidal antiinflammatory drugs. N Engl J Med 1998 Mar 12 338 719-726.

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