NASOGASTRIC OMEPRAZOLE - EFFECTS ON GASTRIC PH IN CRITICALLY ILL PATIENTS

Objective: The efficacy of omeprazole administered by the nasogastric route has not been adequately studied. We sought to determine whether nasogastrically administered omeprazole could effectively maintain an intragastric pH greater than 4.0 in patients hospitalized in a medical intensive care unit. Methods: Patients were considered eligible for t he study if they had a nasogastric feeding tube in place and had not r eceived omeprazole, antacids, or histamine-2 blockers in the 5 days pr eceding study enrollment. Exclusionary criteria included active GI ble eding or a mean baseline gastric pH greater than 4.0. Patients served as their own controls during a 24-h lead-in period, during which basel ine intragastric pH was measured by gastric aspirate. Omeprazole, 20 o r 40 mg, was administered once daily with water through a nasogastric tube. Intragastric pH was measured every 4-8 h for a maximum of 3 days following drug administration, Results: Twenty patients were consider ed eligible for the study; 10 were excluded because of an elevated bas eline gastric pH (n = 8) or because proper gastric aspirates could not be obtained (n = 2). The mean baseline intragastric pH in four patien ts receiving omeprazole 20 mg q.d. was 2.4 +/- 1.1 and increased to 3. 7 +/- 1.6 after drug administration (p = 0.013). The mean baseline int ragastric pH in six patients receiving omeprazole 40 mg q.d. was 2.8 /- 0.8 and increased to 5.7 +/- 1.1 after drug administration (p < 0.0 01). The percentage of intragastric pH values greater than 4.0 after d rug administration was 34.2% in patients receiving omeprazole 20 mg q. d. and 84.7% in those receiving omeprazole 40 mg q.d. Conclusions: Nas ogastric omeprazole 40 mg q.d. is effective in maintaining an intragas tric pH greater than 4.0 in critically ill patients. The nasogastric a dministration of omeprazole offers a cost-effective therapeutic option for acid suppression in patients at risk for stress mucosal ulceratio n.