Prophylactic administration of ranitidine after sclerotherapy of esophageal varices
Pulanić, R.; Vrhovac, B.; Jokić, N.; Rosandić-Pilas, M.; Salamon, V.; Opacić, M.; Rustemović, N.; Korać, B.; Vucelić, B.
International Journal of Clinical Pharmacology Therapy and Toxicology 29(9): 347-351
1991
ISSN/ISBN: 0174-4879 PMID: 1937995 Document Number: 387340
The present trial was carried out to determine the usefulness of H2-receptor antagonist drug therapy for the prevention of esophageal bleeding and esophageal varices in patients who underwent sclerotherapy. According to randomization, out of the 58 patients, 28 received, along with the usual standard therapy, ranitidine and 30 received placebo. Ranitidine, 50 mg, was administered intravenously over a period of 3 days every 8 hours, and then 150 mg of ranitidine was given per os in the evening for one month. For improvement of hemostasis and during the elective sclerotherapies, 1% polidocanol was used as the sclerosant. During each puncture, 2 ml was injected. Injections were paravasal and intravasal. After sclerotherapy, endoscopic examinations were carried out on the third day and one month later. Necrosis was noted in 42% of the patients and esophageal mucosal inflammation in 26%. Esophageal ulcers did not occur. There was no statistically significant difference between the two groups in terms of age, sex ratio, cause of liver cirrhosis, and the Child's classification. The size of the esophageal varices had no effect on the development of esophageal mucosal changes in correlation with the quantity of sclerosant. The comparison of the two groups of patients, sclerosed for hemorrhage and sclerosed electively, showed no statistically significant difference regarding esophageal mucosal changes. No differences between the ranitidine and placebo groups of patients were observed in this indication. It can be concluded that esophageal mucosal changes probably arise as a consequence of the sclerosant, its concentration, quantity and mode of application. The administration of H2-receptor antagonists did not prevent any mucosal changes, what indirectly means that acid flux has no negative effects on the esophageal mucosa following the sclerotherapy. Therefore, the prophylactic use of H2-receptor antagonist drugs is not justified.