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Inflammation of the esophagus from refluxed stomach acid can damage the lining and causebleeding or ulcersalso called esophagitis.

Baclofen, a GABAB receptor agonist, reduces the incidence of TLESR and improves GERDsymptoms in both adult and pediatric GERD patients.

Gastroesophageal reflux disease (GERD) is a common disorder that affects up to 20% of the

population worldwide1,2

Acid-suppressive therapy currently forms the mainstay of treatment for GERD and proton

pump inhibitors (PPIs) are the treatment-ofchoice in this regard.5

6. PPI therapy should be initiated at once a day dosing, before the first meal of the day. (Strong

recommendation, moderate level of evidence). For patients with partial

response to once daily therapy, tailored therapy with adjustment of dose timing and / or twice

daily dosing should be considered in patients with night-time symptoms,

variable schedules, and / or sleep disturbance. (Strong recommendation, low level of evidence).

7. Non-responders to PPI should be referred for evaluation. (Conditional recommendation, low

level of evidence, see refractory GERD section).

8. In patients with partial response to PPI therapy, increasing the dose to twice daily therapy or

switching to a different PPI may provide additional symptom relief. (Conditional

recommendation, low level evidence).

9. Maintenance PPI therapy should be administered for GERD patients who continue to have

symptoms after PPI is discontinued, and in patients with complications

including erosive esophagitis and Barretts esophagus. (Strong recommendation, moderate level

of evidence). For patients who require long-term PPI therapy, it should be administered in the

lowest effective dose, including on demand or intermittent therapy. (Conditional

recommendation, low level of evidence)

10. H 2 -receptor antagonist (H 2 RA) therapy can be used as a maintenance option in patients

without erosive disease if patients experience heartburn relief. (Conditional recommendation,

moderate level of evidence). Bedtime H 2RA therapy can be added to daytime PPI therapy in

selected patients with objective evidence of night-time refl ux if needed, but may be associated

with the development of tachyphlaxis after several weeks of use. (Conditional recommendation,

low level of evidence)

11. Therapy for GERD other than acid suppression, including prokinetic therapy and / or baclofen,

should not be used in GERD patients without diagnostic evaluation. (Conditional recommendation

moderate level of evidence)

12. There is no role for sucralfate in the non-pregnant GERD patient. (Conditional

recommendation, moderate level of evidence)

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13. PPIs are safe in pregnant patients if clinically indicated. (Conditional recommendation,

moderate level of evidence)

For the maintenance treatment of patients with reflux esophagitis and the resolution of symptom

associated with reflux esophagitis, such as heartburn with or without regurgitation, 20 or 40 mg

pantoprazole once daily have been used for 3 years in controlled clinical trials. In continuous

maintenance treatment 20 mg pantoprazole has been used in a limited number of patients for up

to eight years.

Effects of one week oral treatment in healthy volunteers with placebo, pantoprazole 40 mg in the

morning, and standard ranitidine therapy with 300 mg in the evening.

V.A:

1] It is most effective for healing erosive esophagitis when administered at a dose of 40 mg once

daily.

2] Pantoprazole 20 mg or 40 mg daily as maintenance therapy prevents relapse of erosiveesophagitis for 6 to 24 months in most patients with healed disease.*

3]Pantoprazole is a safe, well tolerated and effective initial and maintenance treatment for

patients with nonerosive GERD or erosive esophagitis.

4] 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.

3] 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.

4] oral pantoprazole is safe and well tolerated for short-term treatment of GERD.

5] 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)

6] Erosive esophagitis, show that healing rates with pantoprazole 40 mg are similar in elderly

patients and in younger patients. At 8 weeks, healing rates were 86% in the 44 patients aged 65

years and 83% in the 210 patients aged

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Ref: Aliment Pharmacol Ther25, 14611469

10]Excellent Safety Profile (Evaluated in over 100 clinical trials, pantoprazole has an excellent

safety profile, is as efficacious as other PPIs, and has a low incidence of drug interactions).*

11] Least Drug-Drug Interactions.*

Long-term management of GERD in the elderly with pantoprazole

12] Effective both for acute and long-term treatment with excellent control of relapse and

symptoms.

13] Well tolerated even for long-term therapy.

14] Pantoprazole is significantly efficacious both for acute esophageal healing both for long-term

treatment with excellent control of relapse of esophagitis and symptoms.*

15] Intravenous pantoprazole, 160-240 mg/day administered in divided doses by 15-minute

infusion, rapidly and effectively controlled acid output within 1 hour and maintained control for up

to 7 days in all ZES patients.*

16] Consistent gastric acid suppression, especially at night.*

Ref: Aliment Pharmacol Ther 2002; 16: 829836.

17] Significantly more effective than omeprazole 20 mg in inhibiting meal-stimulated acid secretion. In addition

pantoprazole exhibits a more rapid onset of action.

Ref:Eur J Gastroenterol Hepatol.1999 Nov;11(11):1277-82.

http://www.ncbi.nlm.nih.gov/pubmed/10563540

18] Intravenous pantoprazole has

rapid onset and a

clear dose-related effect, with a

significantly longer duration of action than that ofi.v.famotidine.

19] ] Intravenous pantoprazole, 160-240 mg/day administered in divided doses by 15-minuteinfusion, rapidly and effectively controlled acid output within 1 hour and maintained control for up

to 7 days in all ZES patients.*

Domperidome:

- Enhances LES tone

- Facilitates gastric emptying.

- Reduces Reflux of Gastric Content.

- Enhances GI motility.

http://www.ncbi.nlm.nih.gov/pubmed/10563540http://www.ncbi.nlm.nih.gov/pubmed/10563540http://www.ncbi.nlm.nih.gov/pubmed/10563540http://www.ncbi.nlm.nih.gov/pubmed/10563540

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- Esophageal clearance.

The therapeutic goals are to control symptoms, heal Esophagitis and maintain remission so thatmorbidity is decreased and quality of life is improved.

1. Effective initial and maintenance treatment for patients with nonerosive GERD or

Erosive Esophagitis.

2.Highly efficacious for the initial and maintenance treatment of GERD.

3.Maintenance therapy with pantaprazole prevents relapse of erosive Esophagitis.

Ref:Therapeutics and Clinical Risk Management 2007:3(2) 231243

-Pantru I.V offers:

Rapid onset of action

Significant dose-related effect and

Longer duration of action.

Highly Effective and well tolerated in Gastric Ulcers.2

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2] Aliment Pharmacol Ther; 1995 June; 9(3): 321326.

3]J Clin Gastroenterol.2003 Aug;37(2):132-8.

4] Therapeutics and Clinical Risk Management 2007:3(2) 231243

Maintenance therapy with pantaprazole prevents relapse of erosive Esophagitis.2

http://onlinelibrary.wiley.com/doi/10.1111/apt.1995.9.issue-3/issuetochttp://onlinelibrary.wiley.com/doi/10.1111/apt.1995.9.issue-3/issuetochttp://www.ncbi.nlm.nih.gov/pubmed/12869883http://onlinelibrary.wiley.com/doi/10.1111/apt.1995.9.issue-3/issuetochttp://www.ncbi.nlm.nih.gov/pubmed/12869883