Effect of intravenous ranitidine and omeprazole on intestinal absorption of water, sodium, and macronutrients in patients with intestinal resection

• Published in: Gut Vol. 43; no. 6; pp. 763 - 769
• Main Authors: Jeppesen, P B, Staun, M, Tjellesen, L, Mortensen, P B
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd and British Society of Gastroenterology 01-12-1998; BMJ; BMJ Publishing Group LTD
• Subjects: Adult; Anti-Ulcer Agents - administration & dosage; Beverages; Biological and medical sciences; Crohns disease; Cross-Over Studies; diarrhoea; Double-Blind Method; Drug dosages; Electrolytes; Energy Metabolism; Feces - chemistry; Female; Fluids; Food; General pharmacology; Histamine H2 Antagonists - administration & dosage; human; Humans; Ileostomy - methods; Intestinal Absorption - drug effects; Intestinal Failure; Jejunostomy - methods; Male; Medical sciences; Middle Aged; Nutrition research; omeprazole; Omeprazole - administration & dosage; Ostomy; Parenteral nutrition; Patients; Pharmacokinetics. Pharmacogenetics. Drug-receptor interactions; Pharmacology. Drug treatments; Quality of life; ranitidine; Ranitidine - administration & dosage; Salt; short bowel syndrome; Short Bowel Syndrome - metabolism; Short Bowel Syndrome - surgery; Small intestine; Sodium; Sodium, Dietary - metabolism; Studies; Water - metabolism; Water; Human; Intravenous administration; Gut; Exploration; Surgical resection; Antiulcer agent; Omeprazole; Chemotherapy; Absorption; Sodium; Surgery; Antisecretory agent; Ranitidine; Digestive diseases; Intestinal disease; Biological effect; Macronutrient
• ISSN: 0017-5749; 1468-3288; 1458-3288
• DOI: 10.1136/gut.43.6.763

Background—H2 receptor blockers and proton pump inhibitors reduce intestinal output in patients with short bowel syndrome. Aims—To evaluate the effect of intravenous omeprazole and ranitidine on water, electrolyte, macronutrient, and energy absorption in patients with intestinal resection. Methods—Thirteen patients with a faecal weight above 1.5 kg/day (range 1.7-5.7 kg/day and a median small bowel length of 100 cm were studied. Omeprazole 40 mg twice daily or ranitidine 150 mg twice daily were administered for five days in a randomised, double blind, crossover design followed by a three day control period with no treatment. Two patients with a segment of colon in continuation were excluded from analysis which, however, had no influence on the results. Results—Omeprazole increased median intestinal wet weight absorption compared with no treatment and ranitidine (p<0.03). The effect of ranitidine was not significant. Four patients with faecal volumes below 2.6 kg/day did not respond to omeprazole; in two absorption increased by 0.5-1 kg/day; and in five absorption increased by 1−2 kg/day. Absorption of sodium, calcium, magnesium, nitrogen, carbohydrate, fat, and total energy was unchanged. Four high responders continued on omeprazole for 12–15 months, but none could be weaned from parenteral nutrition. Conclusion—Omeprazole increased water absorption in patients with faecal output above 2.50 kg/day. The effect varied significantly and was greater in patients with a high output, but did not allow parenteral nutrition to be discontinued. Absorption of energy, macronutrients, electrolytes, and divalent cations was not improved. The effect of ranitidine was not significant, possibly because the dose was too low.