Skip to main content

Advertisement

SpringerLink
Log in

Reducing gastric secretions—a role for histamine 2 antagonists or proton pump inhibitors in malignant bowel obstruction?

  • Original Article
  • Published:
Supportive Care in Cancer Aims and scope Submit manuscript

Abstract

Goals of work

Inoperable bowel obstructions are not uncommon in advanced cancer and are associated with a very poor prognosis. Symptom control includes reducing the frequency of vomiting by prescription of antisecretory medications. The most commonly used agents for this are either hyoscine butylbromide or octreotide. Either histamine 2 antagonists or proton pump inhibitors are sometimes recommended as adjuvants to reduce gastric secretions. The aim of this study was to examine the effects of histamine 2 antagonists and proton pump inhibitors and to objectively compare the effects of one agent over another.

Materials and methods

Previously, electronic databases were searched for trials that compared ranitidine versus proton pump inhibitors in their effect on volume of gastric aspirates.

Results

Seven trials were included in a meta-analysis. Pooled outcomes suggest that both proton pump inhibitors and ranitidine reduce gastric volumes, but the most superior agent is ranitidine, which reduces the volume of gastric secretions by an average of 0.22 ml.kg−1; 95% confidence interval 0.04 to 0.41.

Conclusions

Based on well-conducted studies, objective evidence exists that confirms ranitidine will decrease the volume of gastric aspirates. This forms a sound basis from which to develop further research aimed at improving the care of people with malignant bowel obstructions.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Feuer DJ, Broadley KE, Shepherd JH, Barton DP (2000) Surgery for the resolution of symptoms in malignant bowel obstruction in advanced gynaecological and gastrointestinal cancer. Cochrane Database Syst Rev (4):CD002764

  2. Pameijer CR, Mahvi DM, Stewart JA, Weber SM (2005) Bowel obstruction in patients with metastatic cancer: does intervention influence outcome? Int J Gastrointest Cancer 35(2):127–133. doi:10.1385/IJGC:35:2:127

    Article  PubMed  Google Scholar 

  3. Ripamonti C, Bruera E (2002) Palliative management of malignant bowel obstruction. Int J Gynecol Cancer 12(2):135–143. doi:10.1046/j.1525-1438.2002.01103.x

    Article  PubMed  Google Scholar 

  4. Australian Therapeutic Guidelines Palliative Care 2nd ed. Melbourne, Australia: Therapeutic Guidelines Limited; 2005

  5. Ouellette J, Patterson L, P. T. Fast Fact and Concept #091: Interventional Options for Malignant Upper GI Obstruction. American Academy of Hospice and Palliative Care, (www.epercmcw.edu), 2007.

  6. Clark K, Lam L, Gibson S, Currow D (2009) The effect of ranitidine versus proton pump inhibitors on gastric secretions: a meta-analysis of randomised control trials. Anaesthesia (in press).

  7. Jadad AR, Moore RA, Carroll D, Jenkinson C, Reynolds DJ, Gavaghan DJ et al (1996) Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials 17(1):1–12. doi:10.1016/0197-2456(95) 00134-4

    Article  CAS  PubMed  Google Scholar 

  8. Begg CB (1994) Publication Bias. Russell Sage Foundation, New York City

    Google Scholar 

  9. Egger M, Davey Smith G, Schneider M, Minder C (1997) Bias in meta-analysis detected by a simple, graphical test. BMJ 315(7109):629–634

    CAS  PubMed  Google Scholar 

  10. Australian Therapeutic Guidelines Gastrointestinal 1st ed. Melbourne, Australia: Therapeutic Guidelines Limited; 2008

  11. Krouse RS (2007) The international conference on malignant bowel obstruction: a meeting of the minds to advance palliative care research. J Pain Symptom Manage 34(1 Suppl):S1–S6. doi:10.1016/j.jpainsymman.2007.04.005

    Article  PubMed  Google Scholar 

  12. Anthony T, Baron T, Mercadante S, Green S, Chi D, Cunningham J et al (2007) Report of the clinical protocol committee: development of randomized trials for malignant bowel obstruction. J Pain Symptom Manage 34(1 Suppl):S49–S59. doi:10.1016/j.jpainsymman.2007.04.011

    Article  PubMed  Google Scholar 

  13. Ripamonti CI, Easson AM, Gerdes H (2008) Management of malignant bowel obstruction. Eur J Cancer 44(8):1105–1115. doi:10.1016/j.ejca.2008.02.028

    Article  PubMed  Google Scholar 

  14. Ripamonti C, Twycross R, Baines M, Bozzetti F, Capri S, De Conno F et al (2001) Clinical-practice recommendations for the management of bowel obstruction in patients with end-stage cancer. Support Care Cancer 9(4):223–233. doi:10.1007/s005200000198

    Article  CAS  PubMed  Google Scholar 

  15. Salem MR, Wong AY, Mani M, Bennett EJ, Toyama T (1976) Premedicant drugs and gastric juice pH and volume in paediatric patients. Anesthesiology 44(3):216–219. doi:10.1097/00000542-197603000-00010

    Article  CAS  PubMed  Google Scholar 

  16. Hatlebakk JG, Berstad A (1996) Gastro-oesophageal reflux during 3 months of therapy with ranitidine in reflux oesophagitis. Scand J Gastroenterol 31(10):954–958. doi:10.3109/00365529609003113

    Article  CAS  PubMed  Google Scholar 

  17. Pisegna JR (2001) Switching between intravenous and oral pantoprazole. J Clin Gastroenterol 32(1):27–32. doi:10.1097/00004836-200101000-00007

    Article  CAS  PubMed  Google Scholar 

  18. Miller R (1984) Pharmacokinetics and bioavailability of ranitidine in humans. J Pharm Sci 73(10):1376–1379. doi:10.1002/jps.2600731013

    Article  CAS  PubMed  Google Scholar 

  19. Agar M, Webster R, Lacey J, Donovan B, Walker A (2004) The use of subcutaneous omeprazole in the treatment of dyspepsia in palliative care patients. J Pain Symptom Manage 28(6):529–531. doi:10.1016/j.jpainsymman.2004.10.005

    Article  PubMed  Google Scholar 

  20. Davis MP, Furste A (1999) Glycopyrrolate: a useful drug in the palliation of mechanical bowel obstruction. J Pain Symptom Manage 18(3):153–154. doi:10.1016/S0885-3924(99) 00063-9

    Article  CAS  PubMed  Google Scholar 

  21. Escolano F, Castano J, Lopez R, Bisbe E, Alcon A (1992) Effects of omeprazole, ranitidine, famotidine and placebo on gastric secretion in patients undergoing elective surgery. Br J Anaesth 69(4):404–406. doi:10.1093/bja/69.4.404

    Article  CAS  PubMed  Google Scholar 

  22. Hendolin H, Suojaranta-Ylinen R, Alhava E (1993) Effect of single-dose omeprazole and ranitidine on gastric juice acidity and volume in patients undergoing laparotomy. Acta Anaesthesiol Scand 37(5):484–487. doi:10.1111/j.1399-6576.1993.tb03751.x

    Article  CAS  PubMed  Google Scholar 

  23. Nishina K, Mikawa K, Maekawa N, Takao Y, Shiga M, Obara H (1996) A comparison of lansoprazole, omeprazole, and ranitidine for reducing preoperative gastric secretion in adult patients undergoing elective surgery. Anesth Analg 82(4):832–836. doi:10.1097/00000539-199604000-00027

    Article  CAS  PubMed  Google Scholar 

  24. Nishina K, Mikawa K, Takao Y, Shiga M, Maekawa N, Obara H (2000) A comparison of rabeprazole, lansoprazole, and ranitidine for improving preoperative gastric fluid property in adults undergoing elective surgery. Anesth Analg 90(3):717–721. doi:10.1097/00000539-200003000-00038

    Article  CAS  PubMed  Google Scholar 

  25. Uesugi T, Mikawa K, Nishina K, Morikawa O, Takao Y, Obara H (2002) The efficacy of lafutidine in improving preoperative gastric fluid property: a comparison with ranitidine and rabeprazole. Anesth Analg 95(1):144–147

    Article  CAS  PubMed  Google Scholar 

  26. Memis D, Turan A, Karamanlioglu B, Saral P, Ture M, Pamukcu Z (2003) The effect of intravenous pantoprazole and ranitidine for improving preoperative gastric fluid properties in adults undergoing elective surgery. Anesth Analg 97(5):1360–1363

    CAS  PubMed  Google Scholar 

  27. Goel C, Anand LK, Gombar K (2006) Comparative evaluation of single dose intravenous pantoprazole and ranitidine on gastric pH and volume: a double-blind study. J Anaesthesiol Clin Pharmacol 22(2):145–9

    CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Cunningham Centre for Palliative Care, Sacred Heart Palliative Care Services, Darlinghurst Rd, Darlinghurst, NSW, Australia

    K. Clark

  2. Sydney School of Medicine, The University of Notre Dame Australia, Darlinghurst, NSW, Australia

    K. Clark & L. Lam

  3. Palliative and Supportive Services, Southern Adelaide Palliative Care Services, Flinders University, Daw Park, SA, Australia

    D. Currow

  4. Institute for Palliative and Supportive Care Research, Daw Park, SA, Australia

    D. Currow

Authors
  1. K. Clark
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. L. Lam
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. D. Currow
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to K. Clark.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Clark, K., Lam, L. & Currow, D. Reducing gastric secretions—a role for histamine 2 antagonists or proton pump inhibitors in malignant bowel obstruction?. Support Care Cancer 17, 1463–1468 (2009). https://doi.org/10.1007/s00520-009-0609-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00520-009-0609-3

Keywords

Search

Navigation