A pilot study of efficacy and safety of continuous intravenous infusion of pantoprazole in the treatment of severe erosive esophagitis.

Author(s): Cai Q, Barrie M, Olejeme H, Rosenberg MD

Affiliation(s): Division of Digestive Diseases, Emory University School of Medicine, 1365 Clifton Road, Suite B1262, Atlanta, GA 30322, USA. qcai@emory.edu

Publication date & source: 2008-06, Dig Dis Sci., 53(6):1500-5.

Publication type: Randomized Controlled Trial; Research Support, Non-U.S. Gov't

BACKGROUND AND OBJECTIVES: Reflux esophagitis is a common disease. Erosive reflux esophagitis is a more advanced stage of reflux esophagitis. Although death from reflux disease is uncommon, significant morbidity and mortality from complications, such as esophageal ulcer, stricture, and cancer, are not uncommon. Proton pump inhibitors are the popular medication for reflux esophagitis. The objective of this study was to determine the efficacy and safety of continuous intravenous infusion of pantoprazole in the treatment of severe erosive esophagitis. METHODS: From February 2005 to November 2006, all patients with grade 4 erosive reflux esophagitis were screened for the study. Eligible patients were randomized into two groups. Each patient in the study group received intravenous pantoprazole 80 mg loading dose over 5 min, followed by 8 mg/h intravenous infusion for 72 h, then 40 mg orally once a day for 4 days. Each patient in the control group received 40 mg pantoprazole intravenously once a day for 72 h, then orally once a day for 4 days. A second endoscopic gastrointestinal examination (EGD) was performed on treatment days 6-8 (+/-1 day if day 7 was on a weekend) to document any healing of esophagitis in either the study or the control group. RESULTS: In the study group, severe erosive esophagitis healed completely in three patients and significantly in the other three by the time of the second endoscopy. In the control group, severe erosive esophagitis healed partially in five patients, and no improvement was seen at all in one patient by the time of second endoscopy. The difference in the intervention between those two groups was statistically different (P = 0.015). There were no significant complications in either group. CONCLUSIONS: Severe erosive esophagitis can be completely healed in a few days if pantoprazole is given intravenously and continuously for 72 h. It is safe to give pantoprazole intravenously and continuously for treatment of severe erosive esophagitis.