Long-term management of GERD in the elderly with pantoprazole

Abstract

The prevalence of gastroesophageal reflux disease (GERD) increases with age and elderly are more likely to develop severe disease. Older patients often complain of less severe or frequent heartburn than younger patients and they may present with atypical symptoms such as dysphagia, weight loss, or extraesophageal symptoms. Proton pump inhibitors (PPIs) are central in the management of GERD and are unchallenged with regards to their efficacy. They are considered safe and more effective than histamine receptor antagonists for healing esophagitis and for preventing its recurrence using a long term maintenance treatment. PPI have minimal side effects and few slight drug interactions and are considered safe for long term treatment. Pantoprazole is significantly effective both for acute and long-term treatment with excellent control of relapse and symptoms. It is well tolerated even for long-term therapy and its tolerability is optimal. Pantoprazole shows to have minimal interactions with other drugs because of a lower affinity for cytocrome P450 than older PPIs. Although the majority of elderly has concomitant illnesses and receive other drugs, this does not adversely effect the efficacy of pantoprazole because of its pharmacokinetics, which are independent of patient age. Clinical practice suggests that a low dose maintenance of PPIs should be used in older patients with GERD.

Effect of long-term proton pump inhibitor administration on gastric mucosal atrophy: A meta-analysis

“…In the early days of PPI therapy, there was particular concern about hypergastrinaemia in response to profound acid inhibition and resultant endocrine cell hyperplasia with possible tumor formation. [ 21 ] Indeed, it was just such a consideration that led to the temporary halt of the clinical development of omeprazole, the first PPI, and the delay of its widespread introduction. [ 22 ] It is perhaps due to the difficulty in conducting such studies that to date only limited data are available on changes in gastric levels or gastric mucosal endocrine cell numbers after prolonged PPI administration.…”

The Safety of Drugs Used in Acid-related Disorders and Functional Gastrointestinal Disorders

“…As a class, PPIs are well tolerated with few reported side effects, 44-46 the most common being headache, constipation, diarrhea, dizziness, and rash. 1-6 There have been several case reports and series of anaphylactic and allergic reactions to PPI therapy.…”

An update on the use of pantoprazole as a treatment for gastroesophageal reflux disease

“… 14 Like other PPIs, it is a weakly basic prodrug that accumulates within this highly acidic environment and becomes rapidly activated into a cationic sulfonamide. 10 , 13 , 15 The protonated form then covalently binds to specific cysteine residues on the H+/K+ ATPase enzyme, thus irreversibly inactivating the pump. Compared to other PPIs, pantoprazole is less likely to become activated in neutral to moderately acidic environment s (pH 3 to 5).…”