Journal of Isfahan Medical School

Journal of Isfahan Medical School

Comparing the Effects of Pantoprazole and Ranitidine in the Prevention of Post-Operative Gastrointestinal Complications in Patients Undergoing Coronary Artery Bypass Graft Surgery

Document Type : Original Article (s)

Authors
Gholamreza Maasoumi 1
Fatemeh Farahbakhsh 2
Mehran Shahzamani 3
Amir Mirmohammad-Sadeghi 3
1 Associate Professor, Department of Anesthesiology and Critical Care, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
2 Student of Medicine, School of Medicine AND Student Research Committee, Isfahan University of Medical Sciences, Isfahan, Iran
3 Assistant Professor, Department of Surgery, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
Abstract
Background: Patients undergoing coronary surgery are usually treated by anti-thrombus [acetyl salicylic acid (ASA) and anti-coagulant] drugs that lead to emergence of some gastrological problems such as peptic ulcer without any symptom. The present study aims at comparing the effects of pantoprazole and ranitidine in reducing the incidence of gastrointestinal complications in patients undergoing coronary artery bypass graft surgery (CABG).Methods: In a clinical trial, 90 candidates for CABG surgery were randomly divided into two groups of 45 patients. In the first group, pantoprazole and in the second group, ranitidine was prescribed before and after surgery until releasing from intensive care unit (ICU). They were studied in terms of incidence of upper gastrological problems until releasing from ICU and the obtained data were analyzed by SPSS software.Findings: During hospitalization in ICU, 13 patients from pantoprazole and 15 patients from ranitidine group showed gastrological symptoms (28.9% on contrary to 33.3%); however, the difference between two groups was not significant (P = 0.65). The mentioned gastrological symptoms include abdominal distention and vomiting and no case of hematomas and melena was observed in either of groups. The mean duration of hospitalization in ICU in pantoprazole and ranitidine groups were 44.1 ± 12.9 and 51.0 ± 28.1 hours, respectively; however, the difference between two groups was not significant (P = 0.14).Conclusion: There is no advantage in using pantoprazole rather than ranitidine for patients hospitalized in ICU and ranitidine could be preferred due to economical matters.
Keywords
Gastrological problems
Coronary Artery Bypass
Ranitidine
Pantoprazole
  1. Andreoli TE, Carpenter CJ, Griggs RC. Cecil essentials of medicine. 7th ed. Philadelphia, PA: Saunders; 2007. p. 417-8.
  2. Nikoda VV, Bondarenko AV, Kiriushin DN, Liubivyi ED, Stamov VI. Prevention of stress-induced damage of the upper gastrointestinal mucosa in patients during early postoperative period. Anesteziol Reanimatol 2012; (2): 51-5. [In Russian].
  3. Trevor AJ, Katzung BG, Kruidering-Hall MM. Katzung and Trevor's pharmacology: examination and board review. 10th ed. New York, NY: McGraw-Hill; 2013. p. 1067-75.
  4. Juurlink DN, Gomes T, Ko DT, Szmitko PE, Austin PC, Tu JV, et al. A population-based study of the drug interaction between proton pump inhibitors and clopidogrel. CMAJ 2009; 180(7): 713-8.
  5. Dong G, Liu C, Xu B, Jing H, Li D, Wu H. Postoperative abdominal complications after cardiopulmonary bypass. J Cardiothorac Surg 2012; 7: 108.
  6. Allen SJ. Gastrointestinal complications and cardiac surgery. J Extra Corpor Technol 2014; 46(2): 142-9.
  7. Taylor PC, Loop FD, Hermann RE. Management of acute stress ulcer after cardiac surgery. Ann Surg 1973; 178(1): 1-5.
  8. Shin JS, Abah U. Is routine stress ulcer prophylaxis of benefit for patients undergoing cardiac surgery? Interact Cardiovasc Thorac Surg 2012; 14(5): 622-8.
  9. Alebouyeh N, Toefigh M, Ghasemzadeh N, Mirheydari S, Azargashb E. Predictors of gastrointestinal perforation in patients undergoing coronary artery bypass graft (CABG) surgery in Tehran, Iran. Ann Thorac Cardiovasc Surg 2007; 13(4): 251-3.
  10. Goldstein DJ, Aaronson KD, Tatooles AJ, Silvestry SC, Jeevanandam V, Gordon R, et al. Gastrointestinal bleeding in recipients of the HeartWare Ventricular Assist System. JACC Heart Fail 2015; 3(4): 303-13.
  11. Fujita K, Hata M, Sezai A, Sekino H, Minami K. Is prophylactic intravenous administration of a proton pump inhibitor necessary for perioperative management of cardiac surgery? Heart Surg Forum 2012; 15(5): E277-E279.
  12. Vincent JL, Abraham E, Kochanek P, Moore FA, Fink MP. Textbook of critical care. 6th ed. Philadelphia, PA: Saunders; 2011. p. 86-91.
  13. Miller RD, Eriksson LI, Fleisher LA, Wiener-Kronish JP, Young WL. Miller's anesthesia. 7th ed. London, UK: Churchill Livingstone; 2009. p. 218.
  14. Brunicardi F, Andersen D, Billiar T, Dunn D, Hunter J, Matthews J, et al. Schwartz's principles of surgery. 9th ed. New York, NY: McGraw-Hill; 2009. p. 333.
  15. Shin JS, Abah U. Is routine stress ulcer prophylaxis of benefit for patients undergoing cardiac surgery? Interact Cardiovasc Thorac Surg 2012; 14(5): 622-8.
  16. Stchepinsky OA, Theodose YV, Huisman JP, Gaultier YM, Maas HE. Prevention of gastrointestinal bleeding after a cardiac operation. Ann Thorac Surg 1998; 66(1): 306-7.
  17. Patel AJ, Som R. What is the optimum prophylaxis against gastrointestinal haemorrhage for patients undergoing adult cardiac surgery: Histamine receptor antagonists, or proton-pump inhibitors? Interact Cardiovasc Thorac Surg 2013; 16(3): 356-60.
  18. Chen CC, Lee JY, Fang YJ, Hsu SJ, Han ML, Tseng PH, et al. Randomised clinical trial: high-dose vs. standard-dose proton pump inhibitors for the prevention of recurrent haemorrhage after combined endoscopic haemostasis of bleeding peptic ulcers. Aliment Pharmacol Ther 2012; 35(8): 894-903.
  19. Kim KJ, Park MI, Park SJ, Cho SW, Moon W, Kim GM, et al. Effective administration method of intravenous proton pump inhibitor: A novel testing using a BRAVO catheterless pH monitoring system. Turk J Gastroenterol 2011; 22(6): 575-81.
  20. Grus T, Rohn V, Brlicova L, Lindner J, Lambert L, Danes J, et al. Gastrointestinal complications after cardiac surgery: Eight years experience in a single center. Acta Chir Belg 2014; 114(5): 332-7.
  21. Fan H, Zheng Z, Feng W, Wang W, Song Y, Lin Y, et al. Risk factors and prevention of upper gastrointestinal hemorrhage after a coronary artery bypass grafting operation. Surg Today 2010; 40(10): 931-5.
  22. Gon S, Irie Y, Takahashi M. Effects of rabeprazole or famotidine during cardiac surgery on perioperative gastric and esophageal pH readings. Jpn J Thorac Cardiovasc Surg 2006; 54(7): 278-84.
  23. Hata M, Shiono M, Sekino H, Furukawa H, Sezai A, Iida M, et al. Prospective randomized trial for optimal prophylactic treatment of the upper gastrointestinal complications after open heart surgery. Circ J 2005; 69(3): 331-4.
  24. Bateman BT, Bykov K, Choudhry NK, Schneeweiss S, Gagne JJ, Polinski JM, et al. Type of stress ulcer prophylaxis and risk of nosocomial pneumonia in cardiac surgical patients: cohort study. BMJ 2013; 347: f5416.
Journal of Isfahan Medical School
Volume 34, Issue 376 - Serial Number 376
January and February 2016
Pages 270-276

  • Receive Date 07 October 2015
  • Accept Date 06 April 2022