Introduction: Pulmonary aspiration of gastric contents is a potentially life threatening complication of general anaesthesia especially in high risk patients undergoing emergency anaesthesia. Classically,ranitidine has been used to reduce gastric pH and volume. Esomeprazole, the S-isomer of omeprazole, is a newer generation proton pump inhibitor whose effect on gastric pH and volume in emergency surgeries has not been determined. Materials and Methods: This was a prospective, randomised, double blind study to compare the effect of intravenous esomeprazole and ranitidine on gastric pH and volume in patients undergoing emergency appendicectomy. Following induction of anaesthesia, seventy patients of American Society of Anesthesiologists physical status I or II had their gastric contents aspirated via a nasogastric tube. They were then randomised to receive either intravenous esomeprazole 40 mg or intravenous ranitidine 50 mg. A second aspiration of gastric contents was done three hours later. The pH and volume of gastric contents of both aspirations were recorded. Results: Both intravenous esomeprazole and ranitidine significantly reduced the gastric fluid acidity (p=0.001) and volume (p=0.001). There were no significant differences measured between the two groups in terms of gastric fluid pH (p=0.86) and gastric fluid volume (p=0.14) after administration of study drugs. Conclusion Esomeprazole and ranitidine given intravenously were both comparable in reducing the volume and acidity of gastric secretions in patients undergoing emergency appendicectomy.