Comparison of the effect of oral esomeprazole with pantoprazole on gastric pH and gastric volume: “A randomised double blind placebo controlled study”

Aim: This study aims to evaluate the effects of prophylactic use of oral esomeprazole, pantoprazole and Placebo on Gastric pH and Gastric volume at the time of induction (post-induction) and at recovery (pre-extubation), in fasting patients undergoing surgical procedure under general anaesthesia. Material and methods: This prospective, randomized, double blind, placebo controlled study was done in sixty patients of ASA physical status 1or 2, aged between 18 – 65 years, of either sex, scheduled for elective surgery under general anaesthesia, were enrolled for the study. Results: There was no statistically significant difference between the groups with respect to age and weight and also between the groups when compared to premedication to intubation time, premedication to extubation time and duration of surgery. When compared with placebo, the reduction in gastric volume was statistically (P<0.01) and clinically significant in both pantoprazole and esmoprazole group during post induction (V1) and pre extubation(V2) time. However, when comparing with esomeprazole and pantoprazole there was no significant difference between the two groups. In V1 (post- induction) the maximum volume obtained in placebo, pantoprazole and esomeprazole groups were 25ml, 15ml, and 15ml, respectively whereas in V2(pre-extubation) the maximum volume for placebo, pantoprazole and esomeprazole were 20ml, 15ml and 10 ml respectively. In fact we failed to obtain any gastric aspirate in one patient in each groups. Both post-induction(pH1) and pre-extubation (pH2) pH in esomeprazole group, the increase in gastric pH was statistically(P<0.001) and clinically significant when compared with placebo. In pantoprazole group also, the increase in gastric pH was statistically and clinically very highly significant when compared with placebo. Also when comparing esomeprazole and pantoprazole, esomeprazole was more effective in increasing gastric pH which was statistically significant (P<0.01). Conclusion: Both esomeprazole and pantoprazole when administered orally are effective in reducing gastric volume and increasing pH as compared to placebo. Tablet esomeprazole and pantoprazole are comparable with respect to reduction in gastric volume but esomeprazole increase the gastric pH more effectively than pantoprazole.