Controlled study of the effects of intravenous famotidine on intragastric pH in bleeding peptic ulcers

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Abstract
As blood coagulation and platelet aggregation are abolished at pH less than 5.4 the failure of antisecretory drugs to promote haemostasis in bleeding peptic ulcers may reflect inadequate pH control. This study examined the ability of famotidine, a potent, long-acting H2 blocker to maintain intragastric pH above 5.4 in patients presenting with bleeding peptic ulcers. Twenty patients with acute upper gastrointestinal haemorrhage confirmed endoscopically to be related to peptic ulceration (17 duodenal, 3 gastric ulcers), were entered into the study within 24 h of presentation. Each patient was randomly allocated to receive either intravenous famotidine (n = 10) administered as a 10 mg bolus followed by a constant infusion of 3.2 mg/h or similarly administered placebo (n = 10). All patients remained fasted over the 22-h study period. Their median intragastric pH values ranged from 6.8 to 7.9 (median 7.1) in the famotidine group and from 1.1 to 6.9 (median 1.6) in the placebo group (P less than 0.001). Over this same period intragastric pH was greater than 6 for 64%-100% (median 98%) of the recording time in the famotidine group compared with 0%-93% (median 13%) in the placebo group (P less than 0.001). We conclude that intravenous famotidine can maintain intragastric pH greater than 6 in fasting patients with acute upper gastro-intestinal bleeding from peptic ulceration. This provides a rational basis for further studies assessing its clinical efficacy in such patients.