Pantoprazole IV for severe inflammatory disease of the oesophagus

Digestive Diseases and Sciences recently published a preliminary study looking at the effectiveness and safety of pantoprazole given continuously on a ‘drip'(infusion) to treat severe inflammatory disease in the oesophagus.

Severe inflammation and damage (erosions) in the oesophagus (food pipe) is a problem that can occur in people who have been diagnosed with gastro-oesophageal reflux disease. This is a disease similar to but more serious than ‘heartburn’ and is caused by stomach acid travelling up into the oesophagus (refluxing) and causing irritation. Although this condition is not normally serious, if it is left untreated over a long time it can cause painful ulceration or permanent damage to the oesophagus.

While non-drug therapy is recommended to manage this disease, medication also is used to manage flare ups. Medicines with proven benefits in the treatment of reflux disease include the proton pump inhibitors, such as pantoprazole (Somac). In terms of effectiveness, pantoprazole and medicines from the same group have been shown to be the most effective medications to treat severe inflammation of the oesophagus caused by reflux disease. While pantoprazole has been used in a tablet form to treat reflux disease for a long time it has been suspected that if it was given by other ways it could result in quicker healing times.

This study in patients with severe damage (erosions) to the oesophagus caused by reflux disease was designed to examine the effectiveness of pantoprazole when given continuously on a ‘drip’ (infusion). This was done by comparing two groups of patients.

One group received pantoprazole continuously on a drip while the other was given the drug also on a drip but only once a day. Both groups of patients were then given a 40 mg pantoprazole tablet for three days afterwards. The first group received an 80 mg starting dose, followed by 8 mg/hr on a drip for three days while the second group were administered 40 mg on a drip once daily for three days.

The outcome of the treatment in both groups was established by comparing medical photographs taken of the oesophagus before and after treatment. In the patients who received the continuous treatment half the group were completely healed while the rest of the patients were greatly improved. Of the group who received the once daily treatment no complete healing was seen in any patient but some healing was seen in 83% of patients.

It appears that the number of side effects between both groups were similar and these effects cleared by the second day of treatment. The most common side effects seen were headache and diarrhoea.

The results from this study suggest that pantoprazole, when given continuously on a drip, is a safe and effective method to treat patients with severe inflammation and damage in the oesophagus due to reflux disease. This method of delivery may also be further investigated for use as an alternative to pantoprazole tablets.

Due to the preliminary nature of this study however, further investigation in a larger number of patients is needed to reach firm conclusions. When considering this information, it is recommended that you discuss your treatment options in detail with your doctor to determine if this medicine is suitable for you.

Pantoprazole (Somac) is a prescription only medicine and should only be used as directed by your doctor.

Reference:

1. Cai Q, Barrie M, Olejeme H, Rosenburg M. A pilot study of efficacy and safety of continuous intravenous infusion of pantoprazole in the treatment of severe erosive esophagitis. Dig Dis Sci 2007.