Of these tests, endoscopy is the only reliable method to diagnose erosive esophagitis and determine its severity (Tefera et al 1997). Severe GERD (GERD characterized by erosions, ulcers, and strictures) occurs more frequently in men, the elderly, and those of white ethnicity than in other populations (El-Serag and Sonnenberg 1997). Although there are no relevant differences in health-related quality of life between patients with Barretts esophagus, erosive esophagitis and non-erosive GERD (Kulig et al 2003), impairment is proportional to the frequency and severity of symptoms, regardless of the presence or absence of esophagitis (Dimenas et al 1996; Dent et al 1999; Kaplan-Machlis et al 1999), is more severe in females and younger patients (Holtmann et al 2006b) and is exacerbated by the presence of nocturnal symptoms (Farup et al 2001a, 2001b). Efficacy and safety of oral pantoprazole 20 mg given once daily for reflux esophagitis in children. 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). Long-term outcome of medical and surgical therapies for gastroesophageal reflux disease: follow-up of a randomized controlled trial. Control of heartburn strongly predicts improvement in health-related quality of life during the acute treatment of GERD (Pare et al 2003). The omeprazole test is as sensitive as 24-h oesophageal pH monitoring in diagnosing gastro-oesophageal reflux disease in symptomatic patients with erosive oesophagitis. In: Yamada T, Alpers D, et al., editors. 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. Patients perceived average daily symptom load was 1.5 and 2.2 for the pantoprazole and placebo group, respectively (p < 0.05), and pantoprazole-treated patients experienced fewer episodes requiring treatment (p < 0.01), and had a lower discontinuation rate due to insufficient control of symptoms or unsatisfactory treatment. If you have difficulty swallowing the delayed-release capsules, place one tablespoon of soft, cool applesauce in an empty bowl. Complete resolution of heartburn symptoms and health-related quality of life in patients with gastrooesophageal reflux disease. What side effects can this medication cause? Antacids do not usually provide sufficient acid suppression for patients with GERD. GERD can also be diagnosed using 24-hour pH monitoring, but this test has limitations because there is no direct information as to the extent of esophageal damage (Arango et al 2000). Infection with Helicobacter pylori does not appear to contribute to the development of GERD (Csendes et al 1997; Labenz and Malfertheiner 1997; Raghunath et al 2003; Sharma and Vakil 2003). National Library of Medicine Mold JW, Reed LE, Davis AB, et al. The other primary aims are to heal esophageal mucosal damage if it is present and to prevent relapse of erosive esophagitis in the hope that this will reduce the development of other serious complications. Medical treatments for the maintenance therapy of reflux oesophagitis and endoscopic negative reflux disease. Quality of life during acute and intermittent treatment of gastro-oesophageal reflux disease with omeprazole compared with ranitidine. Pantoprazole is more effective than ranitidine in maintaining endoscopically confirmed healing, regardless of initial disease severity or H. pylori status (Metz and Bochenek 2003, Richter et al 2004). Dimenas E, Glise H, Hallerback B, et al. Accessibility Bollschweiler E, Wolfgarten E, Gutschow C, et al. Long-term management of gastro-oesophageal reflux disease with omeprazole or open antireflux surgery: results of a prospective, randomized clinical trial. It is characterized by reflux of the stomach contents into the esophagus, oropharynx, larynx, or airway and is associated with heartburn, acid regurgitation, and dyspepsia (Dent et al 1999; Farup et al 2001a; Shaker et al 2003; Orlando 2006). People who take proton pump inhibitors may also develop fundic gland polyps (a type of growth on the stomach lining). If you are taking the delayed-release tablets, swallow them whole with a full glass of water. Mossner J, Koop H, Porst H, et al. 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). 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). Habermann W, Kiesler K, Eherer A, et al. If symptoms are relieved by therapy, a diagnosis of GERD can be assumed (DeVault and Castell 1999; Fass et al 1999, 2000; Habermann et al 2002). For most patients, initial acid suppressive therapy with a PPI is recommended. Sachs G. Proton pump inhibitors and acid-related diseases. Richter JE, Bochenek W. Oral pantoprazole for erosive esophagitis: a placebo-controlled, randomized clinical trial. The site is secure. Safety and efficacy of pantoprazole 40 mg daily as relapse prophylaxis in patients with healed reflux oesophagitis-a 2-year follow-up. Do not chew or crush the granules. tell your doctor if you are of Asian descent and if you have or have ever had a low level of magnesium, calcium, or potassium in your blood; hypoparathyroidism (condition in which the body does not produce enough parathyroid hormone [PTH; a natural substance needed to control the amount of calcium in the blood]); low levels of vitamin B12 in your body; osteoporosis (a condition in which the bones become thin and weak and break easily); an autoimmune disease (condition in which the body attacks its own organs, causing swelling and loss of function) such as systemic lupus erythematosus; or liver disease. The differential diagnosis of GERD is often difficult. PPIs are associated with a low rate of drug-drug reactions, other than those expected by the lowering of intragastric pH (Labenz et al 2003; Robinson and Horn 2003). Sontag SJ, Sonnenberg A, Schnell TG, et al. The pathogenesis of gastroesophageal reflux disease: the relationship between epithelial defense, dysmotility, and acid exposure. Using this questionnaire in conjunction with the ReQuest- GI (Stanghellini V et al 2005), all dimensions of treatment satisfaction were shown to increase during 4 weeks of treatment with pantoprazole, with good treatment satisfaction reported after the first week of therapy (DeVault et al. Work loss costs due to peptic ulcer disease and gastroesophageal reflux disease in a health maintenance organization. Pantoprazole was more effective than a combined placebo/nizatidine treatment group (p < 0.001) (DeVault et al 2003). The Chiba N. Proton pump inhibitors in acute healing and maintenance of erosive or worse esophagitis: a systematic overview. Evidence to date indicates that any morphological changes in gastric endocrine cells are minimal, self-limiting, nondysplastic and non-neoplastic, suggesting that hypergastrinemia observed during PPI therapy has little clinical significance (Freston 1997). In patients with nonerosive GERD, mucosal breaks are only apparent microscopically and are characterized by the presence of dilated intercellular spaces, whereas in patients with erosive esophagitis, breaks in the esophageal epithelium are visible on endoscopy. Rih I, Hietanen E, Sourander L. Symptoms of gastro-oesophageal reflux disease in elderly people. Labenz J, Armstrong D, Lauritsen K, et al. The burden of selected digestive diseases in the United States. van Rensburg CJ, Honiball PJ, Grundling HD, et al. Proton pump inhibitors block the final step in the secretion of hydrochloric acid by binding to and inactivating H+/K+ATPase in parietal cells of the gastric mucosa (Bell and Hunt 1992; Sachs 1997). 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). Pantoprazole 40 mg is as effective as esomeprazole 40 mg to relieve symptoms of gastroesophageal reflux disease (GERD) after 4 weeks of treatment and superior regarding prevention of symptomatic relapse. Comparable efficacy of pantoprazole and omeprazole to prevent relapse in patients with GERD [abstract]. These figures are likely to underestimate the true prevalence of GERD, since many patients self-medicate and do not seek medical advice or diagnosis (Fendrick 2001). 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. Call your doctor if your symptoms get worse or do not improve after 14 days or if your symptoms return sooner than 4 months after you finish your treatment. Adamek RJ, Behrendt J, Wenzel C. Relapse prevention in reflux oesophagitis with regard to Helicobacter pylori status: a double-blind, randomized, multicentre trial to compare the efficacy of pantoprazole versus ranitidine. Caro JJ, Salas M, Ward A. Healing and relapse rates in gastroesophageal reflux disease treated with the newer proton-pump inhibitors lansoprazole, rabeprazole, and pantoprazole compared with omeprazole, ranitidine, and placebo: evidence from randomized clinical trials. Sharma P, Vakil N. Review article: Helicobacter pylori and reflux disease. Careers, Allgemeines Krankenhaus Hagen, University of Witten/Herdecke, Germany, Correspondence: Theo Scholten Allgemeines Krankenhaus Hagen, Gruenstr. The long-term natural history of gastroesophageal reflux disease. It is important to keep all medication out of sight and reach of children as many containers (such as weekly pill minders and those for eye drops, creams, patches, and inhalers) are not child-resistant and young children can open them easily. An improved evaluation of treatment regimens? Efficacy and tolerability of pantoprazole 40 mg versus 80 mg in patients with reflux oesophagitis. Labenz J, Petersen KU, Rosch W, et al. However, PPIs have the lowest total cost per patient of the available pharmacological treatments, when total costs (defined as the costs of diagnosis and initial treatment, and the costs associated with treatment success, treatment failure and remission) are calculated, despite having higher acquisition costs than other acid suppressive agents (Holzer et al 1998).
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