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Randomized Controlled Trial
. 2015 Jan;29(1):104-12.
doi: 10.1111/jvim.12493. Epub 2014 Dec 24.

Evaluation of the effect of orally administered acid suppressants on intragastric pH in cats

S Parkinson  1 , K Tolbert, K Messenger, A Odunayo, M Brand, G Davidson, E Peters, A Reed, M G Papich
Affiliations
Randomized Controlled Trial

Evaluation of the effect of orally administered acid suppressants on intragastric pH in cats

S Parkinson et al. J Vet Intern Med. 2015 Jan.

Abstract

Background: Acid suppressant drugs are a mainstay of treatment for cats with gastrointestinal erosion and ulceration. However, clinical studies have not been performed to compare the efficacy of commonly PO administered acid suppressants in cats.

Hypothesis/objectives: To compare the effect of PO administered famotidine, fractionated omeprazole tablet (fOT), and omeprazole reformulated paste (ORP) on intragastric pH in cats. We hypothesized that both omeprazole formulations would be superior to famotidine and placebo.

Animals: Six healthy adult DSH colony cats.

Methods: Utilizing a randomized, 4-way crossover design, cats received 0.88-1.26 mg/kg PO q12h fOT, ORP, famotidine, and placebo (lactose capsules). Intragastric pH monitoring was used to continuously record intragastric pH for 96 hours beginning on day 4 of treatment. Plasma omeprazole concentrations at steady state (day 7) were determined by high performance liquid chromatography (HPLC) with ultraviolet detection. Mean percentage time that intragastric pH was ≥ 3 and ≥ 4 were compared among groups using ANOVA with a posthoc Tukey-Kramer test (α = 0.05).

Results: The mean percentage time ± SD that intragastric pH was ≥ 3 was 68.4 ± 35.0% for fOT, 73.9 ± 23.2% for ORP, 42.8 ± 18.6% for famotidine, and 16.0 ± 14.2% for placebo. Mean ± SD plasma omeprazole concentrations were similar in cats receiving fOT compared to those receiving ORP and in a range associated with acid suppression reported in other studies.

Conclusions and clinical importance: These results suggest that both omeprazole formulations provide superior acid suppression in cats compared to famotidine or placebo. Fractionated enteric-coated OT is an effective acid suppressant despite disruption of the enteric coating.

Keywords: Bravo monitoring; Famotidine; Feline; Omeprazole.

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Figures

Figure 1
Figure 1
(A) Placement of Bravo pH capsule in the gastric fundus of a cat under endoscopic guidance using manufacturer supplied delivery device. Mucosa can be seen within the well of the capsule (black asterisk). (B) Bravo pH capsule adhered to fundic mucosa as visualized by endoscope (resting immediately beyond lower esophageal sphincter).
Figure 2
Figure 2
Comparison of the effect of oral placebo, famotidine, fractionated omeprazole tablet (fOT) and omeprazole reformulated paste (ORP) on intragastric pH in six cats on days 4–7 of treatment. Bars represent the mean ± SD percentage of time that intragastric pH was ≥3 (black bars) and 4 (white bars). *Value significantly increased compared to famotidine and placebo. (P < .001) #Value significantly increased compared to placebo (P < .001).
Figure 3
Figure 3
Comparison of the effect of oral placebo (white bars), famotidine (horizontal striped bars), fractionated omeprazole tablet (gray bars) and omeprazole reformulated paste (black bars) on intragastric pH distribution in six cats on days 4–7 of treatment. *Value significantly different from famotidine and placebo (P < 0.001). #Value significantly different from placebo (P < 0.001).
Figure 4
Figure 4
Mean ± SD of omeprazole concentrations in cats receiving omeprazole reformulated paste (closed circle, n = 6) or fractionated omeprazole tablet (open square) on day 7 of treatment.
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