Get access to all handy features included in the IVIS website
- Get unlimited access to books, proceedings and journals.
- Get access to a global catalogue of meetings, on-site and online courses, webinars and educational videos.
- Bookmark your favorite articles in My Library for future reading.
- Save future meetings and courses in My Calendar and My e-Learning.
- Ask authors questions and read what others have to say.
Does ranitidine administration improve gastrointestinal hypomotility in dogs?
Get access to all handy features included in the IVIS website
- Get unlimited access to books, proceedings and journals.
- Get access to a global catalogue of meetings, on-site and online courses, webinars and educational videos.
- Bookmark your favorite articles in My Library for future reading.
- Save future meetings and courses in My Calendar and My e-Learning.
- Ask authors questions and read what others have to say.
Read
PICO question
In dogs presenting with gastrointestinal (GI) hypomotility is ranitidine administration (any route) beneficial in improving GI motility?
Clinical bottom line
Category of research question
Treatment
The number and type of study designs reviewed
One prospective controlled clinical trial and five experimental crossover studies
Strength of evidence
Weak
Outcomes reported
The vast majority of the evidence investigating ranitidine as a prokinetic has been carried out in experimental settings both in vivo with healthy conscious and anaesthetised dogs and in vitro. Under these circumstances ranitidine has shown some prokinetic properties. However, it is difficult to translate these results into reliable clinical recommendations, as the doses mentioned in these studies are often higher than the ones clinically recommended and healthy canine patients might respond differently to clinically affected ones
Conclusion
Although in experimental settings ranitidine has shown some prokinetic activities, no reliable clinical recommendations can be drawn from the appraised studies. There is a need of prospective clinical trials evaluating the administration of ranitidine to dogs presenting with GI hypomotility. Until further relevant studies become available, the efficacy of ranitidine administration as a prokinetic agent in dogs with GI hypomotility remains uncertain
How to apply this evidence in practice
The application of evidence into practice should take into account multiple factors, not limited to: individual clinical expertise, patient’s circumstances and owners’ values, country, location or clinic where you work, the individual case in front of you, the availability of therapies and resources.
Knowledge Summaries are a resource to help reinforce or inform decision making. They do not override the responsibility or judgement of the practitioner to do what is best for the animal in their care.
[...]
Appraisal, application and reflection
This summary stems from the need to look for further guidance in the treatment of a frequently encountered disorder in clinical practice. Dysmotility of the gastrointestinal (GI) tract, characterised by the inhibition of forward movement of ingesta, is a common cause of upper GI signs in dogs (Hall, 2008).
The physiological regulation of coordinated GI movements requires a complex interaction between multiple neurohumoral factors and the enteric nervous system (Whitehead et al., 2016). Any disruption to this finely tuned mechanism can result in oesophageal motility disturbances, delayed gastric emptying and functional ileus (Whitehead et al., 2016). A number of pathologies have been associated with GI hypomotility: infectious diseases (i.e. parvovirosis and ascarid infestation), inflammation of the GI tract (i.e. gastritis, enteritis, ulcers, and post-surgical gastroparesis), neoplasia with severe infiltrative processes (i.e. alimentary lymphoma), metabolic disturbances (i.e. hypokalaemia, hypoadrenocorticism, diabetes mellitus, uraemia), drug administration (i.e. opioids, adrenergic agonists and cholinergic antagonists) and acute stress with significant sympathetic stimulation (Hall, 2008).
Motor neurones located within the GI wall are usually excited by substances like acetylcholine, serotonin and substance P, while other signalling compounds like somatostatin, nitric oxide, catecholamines and gamma-ammino butyric acid tend to inhibit neuromuscular transmission (Whitehead et al., 2016).
The cornerstone of GI hypomotility treatment consists in the administration of agents promoting an excitatory response within the GI nervous system, these drugs are usually referred to as ‘prokinetics’.
The veterinary literature offers few reviews suggesting the use of a number of prokinetic drugs based on their mechanism of action (Hall & Washabau, 1999; and Whitehead et al., 2016).
Ranitidine is frequently mentioned in these reviews and it is often considered in practice for the treatment of dogs with GI hypomotility due to its acetylcholinesterase inhibitor effect (Hall & Washabau, 1999).
A thorough search has been performed using both CAB Abstract and Pubmed databases and applying multiple search word combinations.
The current available literature concerning ranitidine in dogs with upper GI disturbances is mainly focused on its H2-antagonist properties and gastroprotectant activity (Marks et al., 2018).
The few studies centred on its role as an acetylcholinesterase inhibitor and prokinetic have mainly been carried out in experimental settings and on healthy canine patients (Fioramonti et al., 1984; Bertaccini et al., 1985; Mizumoto et al., 1990; Kishibayashi et al., 1994; and Lidbury et al., 2012). Two studies included in vitro experiments (Bertaccini et al., 1995; and Mizumoto et al., 1990) and they both proved ranitidine to have consistent anticholinesterase properties. The same papers also showed a pro-kinetic effect in vivo at clinically relevant doses.
Two in vivo only studies found ranitidine administered both orally and intravenously to have stimulatory effect on GI motility (Fioramonti et al., 1984; and Kishibayashi et al., 1994) however the doses administered in these papers were generally higher than the one currently indicated in clinical practice. Two more recent studies (Favarato et al., 2012; and Lidbury et al., 2012) investigating ranitidine administered at 2 mg/kg either orally or intravenously to healthy dogs who failed to show GI motility enhancement.
Overall, interpretation of the available evidence to draw clinical practice recommendations is significantly hindered by the fact that only healthy patients have so far been included. Furthermore, the populations considered are difficult to compare as some studies evaluated conscious patients and others anaesthetised patients as well as starved animals vs non-starved animals. These are all variables that in humans have been proven to modify GI motility (Luckey et al., 2003) as well as the GI tract response to prokinetic administration (Smout et al., 1985). On top of this there is also a significant variability, amongst the available literature, in the techniques employed to estimate GI motility, as well as discordant dosing regimes and route of administration.
In light of all the above, it is fair to conclude that ranitidine has shown effective prokinetic activity in vitro and in vivo when healthy experimental dogs have been evaluated, although often at dosages higher than the ones commonly recommended in clinical practice. Its efficacy in clinical scenarios with dogs presenting for hypomotility disorders, has yet to be evaluated. Further studies will be needed to try and support its rational use in canine patients with GI hypomotility.
[…]
Get access to all handy features included in the IVIS website
- Get unlimited access to books, proceedings and journals.
- Get access to a global catalogue of meetings, on-site and online courses, webinars and educational videos.
- Bookmark your favorite articles in My Library for future reading.
- Save future meetings and courses in My Calendar and My e-Learning.
- Ask authors questions and read what others have to say.
About
How to reference this publication (Harvard system)?
Author(s)
Copyright Statement
© All text and images in this publication are copyright protected and cannot be reproduced or copied in any way.Related Content
Readers also viewed these publications
Subscribe
Veterinary Evidence is an online, open access, peer-reviewed journal owned and published by RCVS Knowledge. If you would like to receive updates on recent publications, you can register here. If you would like to submit an manuscript for publication in the Veterinary Evidence journal, you can consult the Guidelines for Authors.
Comments (0)
Ask the author
0 comments