Best Orthopedic Doctor in Hyderabad-Dr Mir Jawad Zar Khan

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Congratulations to Dr Dr.Mir Jawad Zar Khan , ( India's Top Orthopaedic Surgeon & Managing Director of Germanten Hospital Hyderabad) for His Research Article on Ranidine and noctural gastric acid in Musculoskeletal disorders in Prestigious Journal IJCP.https://www.drjawadortho.com

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RANITIDINE in the management of Nocturnal Acid Breakthrough Long term EFFICACY SAFETY of

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Copyright 2020 IJCP Publications Ltd. All rights reserved. E-mail: editorialijcp.com Website: www.ijcpgroup.com Ranitidine: A Promising Option in Managing Nocturnal Acid Breakthrough in Patients with Musculoskeletal Disorders Introduction fte circadian rhythm of gastric acid secretion is lowest in the morning greater in the evening and attains the peak around midnight. Several studies have shown a decrease in nocturnal gastric pH in patients with gastroesophageal reflux disease GERD as well as healthy volunteers who take a proton pump inhibitor PPI twice daily. 1 ftis drop in gastric pH termed as nocturnal acid breakthrough NAB is defined as “the presence of intragastric pH 4 during the overnight period for at least 60 continuous minutes in patients taking a PPI”. 2 Weak lower esophageal sphincter function and poor esophageal motility may underline prolonged esophageal acid exposure at night secondary to NAB. fte prevalence of NAB in healthy volunteers varies from 35 to 75 while in patients with GERD it ranges from 67 to 100. Moreover it has been reported that GERD and its complications occur often in various musculoskeletal disorders such as systemic sclerosis. ftus it is important to prescribe appropriate treatment directed at control of NAB in this patient population. 1 Is there a need for adding histamine H 2 receptor antagonist to PPI Numerous studies have shown the efficacy of PPIs in reducing acid secretion. However these agents do not completely eliminate intragastric acidity which warrants the need for an additional agent. 23 For this purpose the investigators have indicated the potential of histamine H 2 receptor antagonists H 2 RAs. ftese drugs help by targeting night time histamine surge. 2 One such H2RA that is considered a potent option is ranitidine. 23 Effectiveness of bedtime ranitidine along with twice daily omeprazole therapy PPI A study conducted by Peghini and co-workers evaluated the effect of a dose of ranitidine with a third dose of omeprazole at bedtime on residual nocturnal acid secretion in patients who received omeprazole twice daily. fte study involved 12 volunteers who underwent overnight intragastric pH monitoring after 7 days of treatment with omeprazole 20 mg twice daily followed by different treatment agents at bedtime. ftese agents were either placebo or additional omeprazole 20 mg or ranitidine 150 mg or ranitidine 300 mg. fte findings revealed that additional omeprazole at bedtime reduced the percentage of time with intragastric pH of 4 from 48 to 31 P 0.005 compared to omeprazole twice daily with placebo at bedtime. However ranitidine at bedtime was more effective at reducing this parameter 5 with 150 mg and 6 with 300 mg P 0.01 versus omeprazole twice daily and at bedtime. Out of 12 volunteers acid breakthrough was reported in 11 volunteers who took placebo at bedtime in 7 who were administered omeprazole in 4 who were given ranitidine 150 mg and in 3 volunteers who were treated with ranitidine 300 mg at bedtime. 2 fte acid breakthrough that occurred in more than 90 of volunteers who received PPI twice daily and in more than 50 who received PPI twice daily and at bedtime suggests that proton pumps were not completely inhibited at even larger doses of PPI. As a consequence histamine or acetylcholine may have activated the parietal cell. PPIs inhibit only actively secreting pumps in the secretory canaliculi sparing those at rest in the tubulovesicles. On the contrary the action of H 2 RA like ranitidine does not depend on food intake. ftus it was rapidly absorbed and absorption was not influenced by food ingestion. fte researchers thus suggested that use of bedtime ranitidine 300 mg along with omeprazole twice a day is an effective therapeutic approach for managing NAB. 2 Given the efficacy of this regime in individuals with NAB it can be suggested that it may be a valuable option for managing NAB in patients with GERD a common symptom of musculoskeletal diseases. References 1. Janiak P ftumshirn M Menne D et al. Clinical trial: the effects of adding ranitidine at night to twice daily omeprazole therapy on nocturnal acid breakthrough and acid reflux in patients with systemic sclerosis--a randomized controlled cross-over trial. Aliment Pharmacol fter. 2007 Nov 1269:1259-65. 2. Tutuian R Castell DO. Nocturnal acid breakthrough - approach to management. Med Gen Med. 200464:11. 3. Peghini PL Katz PO Castell DO. Ranitidine controls nocturnal gastric acid breakthrough on omeprazole: a controlled study in normal subjects. Gastroenterology. 1998 Dec1156:1335-9. Dr Mir Jawad Zar Khan MBBS MS Orthopedics MChOrtho Fellowship in Arthoplasty Germany Managing Director Germanten Hospitals Telangana Consultant Orthopedic Surgeon Specialist in Trauma Joint Replacement Spine Surgery Sports Medicine Pediatric Orthopedics ORTHO

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