In: Pilotto A, Malfertheiner P, Holt P, editors. Call your doctor if you have any unusual problems while taking this medication. Polypharmacy and prescribing quality in older people. Short-term (up to 8 weeks) use of pantoprazole is safe and well tolerated in children and adolescents (aged 5 to 16 years) (Madrazo-de la Garza et al 2003; Tolia et al 2006; Tsou et al 2006). Kaplan-Machlis B, Spiegler GE, Revicki DA. The .gov means its official. Prasad M, Rentz AM, Revicki DA. Pharmacokinetic drug interaction profiles of proton pump inhibitors.
Patients receiving pantoprazole have significantly higher endoscopic remission rates at 12 months (Table 1) and symptomatic control is also significantly better, as measured by the proportion of symptom-free patients at 12 months (Table 1) (Adamek et al 2001), the number of symptom-free days during the 12-month period (83% of days vs 58% of days, p < 0.001 [Richter et al 2004] and 78% vs 48%, p < 0.001 [Metz and Bochenek 2003]) and the number of nights without heartburn (93% of nights vs 77% of nights, p = 0.001 [Richter et al 2004] and, p = 0.002 [Metz and Bochenek 2003]). 
The effective treatment of GERD provides symptom resolution and high rates of remission in erosive esophagitis, lowers the incidence of GERD complications, improves health-related quality of life and reduces the cost of this disease. In this study, only 4 of 111 patients had adverse events definitely related to pantoprazole. Lauritsen K, Devire J, Bigard MA, et al. Bollschweiler E, Wolfgarten E, Gutschow C, et al. Plein K, Hotz J, Wurzer H, et al. Healing and relapse of severe peptic esophagitis after treatment with omeprazole. Wiklund I, Bardhan KD, Muller-Lissner S, et al. The main aim of GERD treatment should be rapid and sustained achievement of comprehensive symptom resolution, because this is associated with marked improvementoften normalizationin health-related quality of life (Revicki et al 1999). Because of this different symptom profile of GERD in the elderly, the disease, particularly in milder form, may remain undiagnosed for a considerable period of time (Maekawa et al 1998) resulting in hospital admittance for more severe disease (Zimmerman et al 1997). The exact pathologic process by which this occurs is complex and yet to be fully characterized, but there are two requirements for heartburn, regardless of a diagnosis of erosive or nonerosive disease: these are high concentrations of acid within the esophageal lumen (reflux) and a damaged esophageal epithelium. Similarly, many patients are not aware that they have GERD (Hollenz et al 2002). These findings are in agreement with data for nonelderly populations. Myrvold HE, Lundell L, Miettinen P, et al. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. Watson DI, Jamieson GG, Baigrie RJ, et al. In addition, oral pantoprazole has been shown to improve the quality of life of patients with GERD and is associated with high levels of patient satisfaction with therapy. Excess gastroesophageal reflux in patients with hiatus hernia is caused by mechanisms other than transient LES relaxations. Your doctor will probably tell you not to take omeprazole if you are taking this medication. Patients initially received pantoprazole 40 mg daily for 8 weeks and 81% achieved documented healing of erosive esophagitis. Information is also available online at https://www.poisonhelp.org/help. Although no trials of maintenance therapy have reported quality of life assessments for pantoprazole, several studies have evaluated the effect of short-term pantoprazole on health-related quality of life, and results of these studies generally showed the PPI to improve health-related quality of life (de-Souza-Cury et al 2006) and be superior to H2-receptor antagonists (Kaspari et al 2001; Pare et al 2003). Patients with GERD have significantly (p < 0.05) poorer health-related quality of life than the general population (McDougall et al 1996; Revicki et al 1998; Enck et al 1999; Kaplan-Machlis et al 1999; Farup et al 2001a; Pare et al 2003), patients with diabetes or hypertension (Revicki et al 1998; Enck et al 1999), and patients with severe angina pectoris or mild heart failure (Dimenas et al 1993). Proton pump inhibitors are widely recognized as the most effective agents for treating GERD. Unless your doctor tells you otherwise, continue your normal diet. Furthermore, as elderly are taking multiple medications at the same time, or drugs with a narrow therapeutic window, drug interactions may be of particular importance in those patients. At 8 weeks, healing rates were 86% in the 44 patients aged 65 years and 83% in the 210 patients aged <65 years. The nonprescription delayed-release tablets are usually taken once a day in the morning at least 1 hour before eating for 14 days in a row. Randomized clinical trials comparing the efficacy of maintenance therapy with pantoprazole versus other acid suppressing agents in patients with healed erosive esophagitisa. Johnson DA, Fennerty MB. If you are using the 10-mg packet, place 1 tablespoonful (15 mL) of water in a container. Ask your pharmacist or doctor for a copy of the manufacturer's information for the patient. Richter JE. Sontag SJ, Sonnenberg A, Schnell TG, et al. AHFS Patient Medication Information. Mean intensities of heartburn were significantly lower in the pantoprazole compared with the esomeprazole treatment group during the 6 months on-demand treatment (1.10 vs 1.33, p = 0.0096) (Figure 1) (Scholten, Bohuschke, et al 2005). Clinical efficacy and safety of pantoprazole in severe acid-peptic disease during up to 10 years maintenance treatment. Open the delayed-release capsule and carefully empty all the granules inside the capsule onto the applesauce. Patients with symptomatic or mild erosive GERD are therefore ideal candidates for on-demand or intermittent treatment (Bardhan 2003). In these studies, oral pantoprazole at doses of 20 mg and 40 mg once daily for 8 weeks rapidly reduced symptom scores in 53 children aged 5 to 11 years with erosive or histological esophagitis (p < 0.001) (Tolia et al 2006) and in 136 adolescents aged 12 to 16 years with clinically diagnosed GERD (p < 0.001) (Tsou et al 2006). Dajani EZ. Oral pantoprazole 20 mg daily also provided clinical improvement in symptoms of erosive esophagitis in children aged 6 to 13 years enrolled in a small uncontrolled trial (Madrazo-de la Garza et al 2003). H2-receptor antagonists are significantly more effective than antacids for suppressing acid secretion, but have a slower onset of action (Netzer et al 1998; Wyeth et al 1998). Nighttime heartburn is an under-appreciated clinical problem that impacts sleep and daytime function: the results of a Gallup survey conducted on behalf of the American Gastroenterological Association. An improved evaluation of treatment regimens?
Drink the entire mixture within 30 minutes. Gastroesophageal reflux disease: pathophysiology and pharmacology overview. Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them. What is the best way to manage GERD symptoms in the elderly? A double-blind, randomized comparison of omeprazole Multiple Unit Pellet System (MUPS) 20 mg, lansoprazole 30 mg and pantoprazole 40 mg in symptomatic reflux oesophagitis followed by 3 months of omeprazole MUPS maintenance treatment: a Dutch multicentre trial. Thus, monitoring of serum gastrin levels and fundic enterochromaffin-like cells is of no clinical relevance even during long-term therapy with PPIs (Arnold 1994). Mold JW, Reed LE, Davis AB, et al. Shaw MJ, Fendrick AM, Kane RL, et al. Chiba N, De Gara CJ, Wilkinson JM, et al.
Long-term acid control and proton pump inhibitors: interactions and safety issues in perspective. Glatzel D, Abdel-Qader M, Gatz G, et al. What special dietary instructions should I follow? Of the PPIs, omeprazole has the highest risk for hepatic-based interactions, and rabeprazole and pantoprazole appear to have the lowest risk (Robinson and Horn 2003). PMC legacy view After 7 days, scores for all assessment scales improved more with pantoprazole than nizatidine. Tefera L, Fein M, Ritter MP, et al. Efficacy and safety of oral pantoprazole 20 mg given once daily for reflux esophagitis in children. GERDyzer treatment satisfaction module: correlation with symptom assessment by ReQuestGI (abstract). Work loss costs due to peptic ulcer disease and gastroesophageal reflux disease in a health maintenance organization.
FOIA Kahrilas PJ, Fennerty MB, Joelsson B. High- versus standard-dose ranitidine for control of heartburn in poorly responsive acid reflux disease: a prospective, controlled trial. These results show that pantoprazole is highly effective for healing and reducing the relapse of erosive esophagitis, and that discontinuing active treatment after 6 months is associated with a significant increase in the risk of relapse. One-year prophylactic efficacy and safety of pantoprazole in controlling gastro-oesophageal reflux symptoms in patients with healed reflux oesophagitis. In comparisons with other active treatments, pantoprazole has demonstrated high remission rates. The impact of treatment for gastro-oesophageal reflux disease on health-related quality of life: a literature review.
Surgery is not an ideal option for the majority of patients, and many patients will continue to use acid reducing medications on a regular basis after undergoing surgery (Spechler et al 2001; Johnson 2003). Updated guidelines for the diagnosis and treatment of gastroesophageal reflux disease. The GERDyzer covers 10 dimensions of quality of life (general well-being, pain/discomfort, physical health, energy, daily activities, leisure activities, social life, diet/eating/drinking habits, mood and sleep) and has demonstrated very high internal consistency, good test-retest reliability, responsiveness and construct validity in patients treated with pantoprazole (Holtmann et al 2005). PPIs thus produce a considerable but dose-dependent elevation of gastric pH (Dajani 2000). Take omeprazole exactly as directed. It is common for many patients with mild disease and infrequent symptom relapses to use a PPI only when symptoms demand. Gastroesophageal reflux disease (GERD) is a chronic, relapsing disease that infrequently progresses (Sontag et al 2006) but is associated with a range of potentially serious esophageal complications (esophageal ulcer, esophageal stricture or obstruction, Barretts esophagus or esophageal cancer) and extra-esophageal diseases such as respiratory problems, chest pain, angina, and increased mortality (Ruigomez et al 2004). The omeprazole test is as sensitive as 24-h oesophageal pH monitoring in diagnosing gastro-oesophageal reflux disease in symptomatic patients with erosive oesophagitis. National Library of Medicine Add the contents of the powder packet and stir. As no pharmaceutical agent can fully correct the motor dysfunction responsible for acid reflux into the esophagus, acid suppression remains the most effective way to relieve symptoms and to promote healing of esophagitis in patients with GERD (Orlando 1997). Oral pantoprazole has greater efficacy than that of H2-receptor antagonists and generally has similar efficacy to other PPIs for the initial and maintenance treatment of GERD. Omeprazole may cause other side effects. In 2002, the incidence of esophageal adenocarcinoma was 26 per 100 000 person-years among patients with previously diagnosed erosive esophagitis (versus 2.79 per 100 000 person-years in the general population) in a Danish community (Lassen et al 2006). The treatment of GERD improves symptoms and health-related quality of life outcomes (Wiklund et al 1998; Revicki et al 1999; Prasad et al 2003). Oral pantoprazole has greater efficacy than histamine H2-receptor antagonists and generally similar efficacy to other proton pump inhibitors for the initial and maintenance treatment of GERD. What special precautions should I follow? These latter findings are supported by the results of two recently completed studies. Oral pantoprazole is a safe, well tolerated and effective initial and maintenance treatment for patients with nonerosive GERD or erosive esophagitis. Similarly, in comparison with ranitidine, quality of life parameters tended to improve more with pantoprazole 20 mg once daily than ranitidine 150 mg twice daily according to the gastrointestinal quality of life index (GIQLI) and SF-36, with a significant advantage seen for pantoprazole in the SF-36 vitality score (p < 0.05), in a mixed population of patients with nonerosive GERD or endoscopically confirmed erosive esophagitis. Copyright, 2022. Sharma P, Vakil N. Review article: Helicobacter pylori and reflux disease. Evaluation of omeprazole, lansoprazole, pantoprazole, and rabeprazole in the treatment of acid-related diseases. If you are using the 2.5-mg packet, place 1 teaspoonful (5 mL) of water in a container. Adequate treatment of GERD should either prevent repeated reflux of gastric contents into the esophagus or reduce the damaging effect of gastric acid. Results of a prospective study have confirmed the efficacy of oral pantoprazole in 164 patients aged 65 years with Savary-Miller grade I-III GERD. PPIs provide more rapid symptom control and better healing of erosive esophagitis than both H2-receptor antagonists and antacids (Chiba et al 1997; Dent et al 1999; DeVault and Castell 1999; Caro et al 2001; Donnellan et al 2004). Pantoprazole 20 mg once daily has generally shown similar efficacy for preventing endoscopic or symptomatic relapse to pantoprazole 40 mg once daily (Escourrou et al 1999; Plein et al 2000). Pantoprazole has also demonstrated efficacy in difficult-to-treat patients. Symptomatic remission rates after 12 months were also similar with each pantoprazole regimen: 77% with the 20 mg dose and 76% with the 40 mg dose. Prescription omeprazole is used alone or with other medications to treat the symptoms of gastroesophageal reflux disease (GERD), a condition in which backward flow of acid from the stomach causes heartburn and possible injury of the esophagus (the tube between the throat and stomach) in adults and children 1 year of age and older.
Do not take nonprescription omeprazole for immediate relief of heartburn symptoms. Arango L, Angel A, Molina RI, et al. Intermittent and on-demand use of proton pump inhibitors in the management of symptomatic gastroesophageal reflux disease. Vakil N, Shaw M, Kirby R. Clinical effectiveness of laparoscopic fundoplication in a U.S. community. On-demand therapy with pantoprazole 20 mg as effective long-term management of reflux disease in patients with mild GERD: the ORION trial. Lauritsen K, Jaup B, Carling L, et al. Mulder CJ, Westerveld BD, Smit JM, et al. Scholten T, Gatz G, Hole U. Once-daily pantoprazole 40 mg and esomeprazole 40 mg have equivalent overall efficacy in relieving GERD-related symptoms. Determining the cost of gastroesophageal reflux disease: a decision analytic model. Bochenek WJ, Mack ME, Fraga PD, et al. All Rights Reserved. Richter JE, Bochenek W. Oral pantoprazole for erosive esophagitis: a placebo-controlled, randomized clinical trial. Multicenter, randomized, double-blind study comparing 10, 20 and 40 mg pantoprazole in children (511 years) with symptomatic gastroesophageal reflux disease. Nwokolo CU, Smith JT, Gavey C, et al. Clinical pharmacology of proton pump inhibitors: what the practising physician needs to know. On-demand treatment with oral pantoprazole 20 mg or 40 mg daily provided effective symptomatic control in 634 patients with endoscopically confirmed Savary-Miller grade 0/I GERD and heartburn, with the mean perceived average daily symptom load of heartburn over a 6-month period reduced from 3.93 with placebo to 2.71 with the 40 mg dose and 2.91 with the 20 mg dose (p < 0.0001 for both pantoprazole doses vs placebo) (Scholten, Dekkers, et al 2005). The differential diagnosis of GERD is often difficult. Comparison of the effect of the antacid Rennie versus low-dose H. Numans ME, Lau J, de Wit NJ, et al.
Prescription omeprazole is also used to treat conditions in which the stomach produces too much acid such as Zollinger-Ellison syndrome in adults. Long-term outcome of medical and surgical therapies for gastroesophageal reflux disease: follow-up of a randomized controlled trial. In 66 patients with aggressive, complicated GERD refractory to H2-receptor antagonists, but healed with oral pantoprazole, continued therapy with oral pantoprazole 40 mg daily maintained remission in most patients at 24 months (percentages were not reported) (Bardhan et al 2001). Of these tests, endoscopy is the only reliable method to diagnose erosive esophagitis and determine its severity (Tefera et al 1997). It has been reported that GERD affects an estimated 19 million individuals in the US (Sandler et al 2002), and it can affect up to one-third of adults (Haag and Holtmann 2003). The only study identified, a modelling study in the Netherlands, showed that pantoprazole may have a more favorable pharmacoeconomic profile than omeprazole. The discontinuation rate due to insufficient control of heartburn or unsatisfactory treatment (insufficient control of heartburn or other gastrointestinal symptoms) was significantly lower in both pantoprazole groups than in the placebo group, despite placebo recipients using significantly more antacid therapy (p < 0.05 for all pantoprazole vs placebo comparisons). Short-term therapeutic trial of proton pump inhibitors in suspected extraesophageal reflux.
With time, patients with GERD may develop histopathological changes such as Barretts esophagus (Spechler and Goyal 1986). Fast onset of action: the initial dose of pantoprazole is superior to esomeprazole in reducing the frequence and intensity of acid episodes determined by ReQuest [abstract], Holtmann G, Malagelada J, Chassany O, et al. Esophagitis: incidence and risk of esophageal adenocarcinomaa population-based cohort study. In comparison with pharmacotherapy in the US, surgical antireflux therapy (open Nissen fundoplication) produces no significant differences in grade of esophagitis, frequency of treatment of esophageal stricture, and subsequent antireflux operations, incidence of esophageal cancer, quality of life measures, and overall satisfaction with antireflux therapy when assessed more than 9 years after initiation of therapy (Spechler et al 2001).
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