Ranitidine versus omeprazole as a prophylaxis of upper gastro intestinal tract bleeding in ventilated and in critically III non-ventilated children

ABSTRACT

Stress-related mucosal disease [SRMD] refers to superficial erosions or ulceration of the proximal gastrointestinal mucosa in acuto illness. The contributory rolo of stross induced high gastric activity was documontod and sovoral medications were triod to provont SHMD in high risk pationls in PICU The aim of this work was to compare the efficacy of ranitidine versus omeprazole for prophylaxis of UGITB in mechanicaily ventilated and in critically ill non-ventilated pediatric patients admitted to PICU. Design: 9-months prospective controlled study. Setting: Pediatric ICU, Pediatric Department, Tanta University Hospital Patients and Methods: 60 critically ill children were included [30 males and 30 females]. Every patient was subjected to SOFA scoring. Gastric juice aspirate samples were examined for occult blood by chromatographic immunoassay and aspirate pH by pH meter. In 40 patients either IV ranitidine or omeprazole was started by 3[rd] day of admission and continued for 4 days. No UGITB prophylactic therapy was given to 20 patients [controls]. In patients receiving IV ranitidine, IV omeprazole and controls the prevalence of UGITB by day 6 in unventilated cases was 40%, 10% and 70% and In in ventilated cases was 50%, 20%, and 70% respectively. In patients receiving IV ranitidine successful control of average gastric pH to >/= 4 occurred in 70% of cases by day 3, and in 40%, 30% and 20% by days 4, 5 and 6 respectively. In patients receiving IV omeprazole the relative values were 90% by day 3 and 100% later on. Conclusions: IV omeprazole and IV ranitidine prophylactic therapy decreased the incidence of SRMD and increased the gastric pH to >/= 4.0 which was more obvious and sustained in those receiving omeprazole. IV omeprazole is preferred for SUP in PICU patients