Peptic ulcer: duodenal: pantoprazole heals better than ranitidine

Clinical bottom line (level 1b)

  1. Patients with active duodenal ulcers who received pantoprazole compared with ranitidine were more likely to have healing (NNT = 4 at 4 weeks) .
Menghelli et al: Am J Gastroenterol 2000; 85 : 62-66
Expires January 2004

The study

Double-blinded ?concealed randomised trial without intention-to-treat
Setting: 5 acute hospitals, Brazil

222 patients (aged 18 to 70; mean 37, 55% male) with active duodenal ulcers (confirmed endoscopically within 72 hours)

Excluded if
  • severe concomittant illness
  • pregnant, breast-feeding or of child-bearing potential not using an effective contraceptive
  • potential compliance doubtful
  • concurrent pyloric or gastric ulcers,or esophagitis
  • signs or symptoms suggesting gastrinoma
  • use of antiulcer agent within previous 5 days
  • chronic NSAID or steroid use; or use of medication that might interact with study drugs
  • known hypersensitivity to study drugs
  • > 2 ulcers, or complications including haemorrhage, perforation, stenosis
  • aged < 18 , > 75
  • ulcer < 0.5 cm or > 2cm in diameter

Control Group: (n = 111, 94 analysed): ranitidine 300 mg at night for 28 days
Experimental Group: (n = 111, 103 analysed): pantoprazole 40 mg in the morning for 28 days

89% followed for 4 weeks
Outcome notes:
  • healed ulcer : confirmed endoscopically

The evidence

Outcome Time to outcome CER EER RRR
(95% CI)		 ARR
(95% CI)		 NNT
(95% CI)
healed ulcer 4 weeks 70
(63.6%)		 100
(90.1%)		 -43%
(-67% to -22%)		 27.0%
(16.5% to 37.6%)		 4
(3 to 6)
adverse events weeks 3
(2.70%)		 3
(3.60%)		 -333%
(-480% to 69%)		 -0.90%
(-5.50% to 3.70%)		 -110
(NNT = 27 to infinity;
NNH = 18 to infinity)

Citation

  1. Menghelli UG, Zaterka S, Castro L, et al: pantoprazole v. ranitidine in the treatment of duodenal ulcer: a multicentre study in Brazil. Am J Gastroenterol 2000; 85 : 62-66
Search Terms: from ACP Journal Club other articles noted
Contributor: Chris Ball, January 2002
Reviewer:

Clinical Question.
Patient active duodenal ulcer
Intervention or Exposure pantoprazole
Comparison ranitidine
Outcome healed ulcer