Lansoprazole Preventing Gastroduodenal Stress Ulcerations
|First Received Date ICMJE||September 20, 2005|
|Last Updated Date||January 2, 2008|
|Start Date ICMJE||September 2005|
|Primary Completion Date||Not Provided|
|Current Primary Outcome Measures ICMJE
|Original Primary Outcome Measures ICMJE||Same as current|
|Change History||Complete list of historical versions of study NCT00220909 on ClinicalTrials.gov Archive Site|
|Current Secondary Outcome Measures ICMJE
|Original Secondary Outcome Measures ICMJE||Same as current|
|Current Other Outcome Measures ICMJE||Not Provided|
|Original Other Outcome Measures ICMJE||Not Provided|
|Brief Title ICMJE||Lansoprazole Preventing Gastroduodenal Stress Ulcerations|
|Official Title ICMJE||A Prospective, Randomized, Double-Blind Protocol to Compare the Efficacy of Lansoprazole to Ranitidine in Healing Pre-Existing and/or Preventing the Development of Gastroduodenal Stress Ulceration and Postoperative Bleeding in Patients Undergoing Elective Coronary Artery Bypass Graft or Cardiac Valve Replacement Surgery|
The primary objective of this study is to determine whether lansoprazole, administered intravenously, can protect patients undergoing cardiac surgery from the development of and/or progression of previously undetected acid/peptic disorders (erosive esophagitis, gastric ulcer, duodenal ulcer, diffuse gastritis, duodenitis) as measured by the Lanza score and LA classification for esophageal injury.
The secondary objectives of this study are:
This is a randomized, double-blind single center study which compares the efficacy of lansoprazole by IV infusion daily (60 mg bolus followed by 6 mg per hour) compared to ranitidine 50 mg IV q12 h in healing pre-existing and preventing perioperative stress ulcers and associated upper GI bleeding.
Patients will undergo a complete history including a medication history for intake of ASA/NSAIDs/anticoagulants/antiplatelet agents, physical examination, complete blood count, complete metabolic profile, ECG's and chest x-rays which rule out an exclusionary illness. Female subjects will have a urine pregnancy test performed. They will then sign an informed consent to participate in this randomized, double-blind study protocol. Patients will be excluded if they are currently using acid suppressive therapy or if they have a history of gastric/duodenal ulcers or gastroesophageal reflux disease that has required acid suppressive therapy.
Patients will be randomized to receive either lansoprazole or ranitidine intravenously by continuous intravenous infusion on the morning of surgery and on each of the subsequent 4 days. Computer randomization will be used with the code kept by pharmacy. The allocation will be concealed. Medication will be delivered in a sealed, unlabeled container from the pharmacy. Patients will be stratified between placebo and lansoprazole by preceding ASA/NSAID use. Lansoprazole will be given as a 60 mg bolus preoperatively followed by 6 mg per hour throughout the duration of the study. At the time of airway intubation in the operating room for the surgery, a nasogastric tube with a built-in intragastric pH electrode (Zinetics, Inc) will be passed into the mid-stomach by the anesthesiologist in place of the standard nasogastric tube. Intragastric pH will be measured during the perisurgical period until the morning of postoperative day 4, 72 hours after surgery. At that time, the nasogastric tube/pH probe will be removed and patients will undergo esophagogastroduodenoscopy (EGD) under sedation with midazolam and fentanyl. During the endoscopy, the maximum number of submucosal hemorrhages and erosions in an endoscopic field from the anterior and posterior walls of the antrum will be counted. Modified Lanza scores for both the stomach and the duodenum will be determined to quantify gastric and duodenal erosions and ulcerations6. We will also determine the LA classification of esophageal injury and inflammation. Before removal of the endoscope, a wireless pH capsule (Bravo pH capsule; Medtronic, Inc) will be placed in the body of the stomach 12 cm below the squamocolumnar junction for an additional two day measurement of intragastric pH or until the time of discharge from the hospital if less than 48 hours from the EGD. Thus, intragastric pH will be monitored from the morning that the patient undergoes surgery for 6 days or until the time of discharge.
After completion of surgery, all patients will be followed with hemoglobin and hematocrit every 12 hours; all stools will be tested for blood qualitatively (Hemoccult) and quantitatively (Hemaquant). Postoperatively, hemoglobin level will be maintained at or above 10 gm% using packed red blood cell transfusions as needed. Transfusion requirements will be quantified. The times at which patients resume oral intake will be noted along with specific data on oral liquid and solid food composition.
|Study Type ICMJE||Interventional|
|Study Phase||Phase 4|
|Study Design ICMJE||Allocation: Randomized
Endpoint Classification: Efficacy Study
Intervention Model: Parallel Assignment
Primary Purpose: Prevention
|Condition ICMJE||Patients Undergoing Elective Coronary Artery Bypass Graft|
|Intervention ICMJE||Drug: Lansoprazole|
|Study Arm (s)||Not Provided|
|Publications *||Not Provided|
* Includes publications given by the data provider as well as publications identified by ClinicalTrials.gov Identifier (NCT Number) in Medline.
|Recruitment Status ICMJE||Terminated|
|Estimated Enrollment ICMJE||40|
|Completion Date||January 2006|
|Primary Completion Date||Not Provided|
|Eligibility Criteria ICMJE||
Patients with symptomatic coronary artery disease or valvular heart disease who require corrective cardiac surgery will be eligible to participate in this study.
|Ages||18 Years to 65 Years|
|Accepts Healthy Volunteers||No|
|Contacts ICMJE||Contact information is only displayed when the study is recruiting subjects|
|Location Countries ICMJE||United States|
|NCT Number ICMJE||NCT00220909|
|Other Study ID Numbers ICMJE||TU4572|
|Has Data Monitoring Committee||Not Provided|
|Responsible Party||Not Provided|
|Study Sponsor ICMJE||Temple University|
|Collaborators ICMJE||Not Provided|
|Information Provided By||Temple University|
|Verification Date||January 2008|
ICMJE Data element required by the International Committee of Medical Journal Editors and the World Health Organization ICTRP