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Intravenous Protonix, Not Histamine 2-Receptor Inhibitors, to Prevent Erosive Esophagitis in ICU Patients

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Han, Yoosun, M.D.; Nam, Jae W., M.D.; Barrie, Mahmoud, M.D.; Rosenberg, Marc D., M.D.; Cai, Qiang, M.D.

American Journal of Gastroenterology: September 2005 - Volume 100 - Issue - p S35
Supplement Abstracts Submitted for the 70th Annual Scientific Meeting of the American College of Gastroenterology: ESOPHAGUS
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Medicine, Emory University School of Medicine, Atlanta, GA.

Purpose: Gastroesophageal reflux disease (GERD) is a very common disease that affects 20–50% of adults in Western Countries. The disease can be divided into three clinical categories: nonerosive reflux disease (NERD), erosive reflux disease (ERD), and Barrett's esophagus. Our prior retrospective study showed patients in Intensive Care Unit (ICU) were prone to have ERD, despite using of histamine 2-receptor inhibitors as prophylaxis. The aim of this study is to examine whether Protonix given through continuous intravenous (IV) infusion for 72 hours is superior to Protonix given through once a day IV injection in treatment of ERD.

Methods: In the last few months, patients with grade 4 ERD confirmed by esophgogastroduodenoscopy (EGD) were enrolled in the study. The patients were randomly divided into 2 groups. Group 1 received Protonix 80 mg IV bolus, followed by 8 mg/hour IV drip for 72 hours. Group 2 received Protonix 40 mg IV once a day for 72 hrs. Both groups then received Protonix 40 mg by mouth once a day after the initial 72 hrs. About 7 days after the initial EGD, a repeat EGD was performed for the patients in both groups.

Results: Six patients were identified by EGD in our hospital during the study period. Those patients were ICU patients. They all had IV histamine 2-receptor inhibitors for prophylaxis. Two patients refused the study, the other four were enrolled. In day 7 after the initial EGD, ERD completely resolved in three patients (2 patients in Group 1, 1 patient in Group 2), partially resolved in one patient (Group 2 patient).

Conclusions: ICU patients are prone to have ERD despite receiving intravenously histamine 2-receptor inhibitors. Histamine 2-receptor inhibitors may not be sufficient prophylaxis for ERD in ICU patients. Proton pump inhibitors intravenously may be better for those patients to prevent ERD. Continuous IV infusion of Protonix for 72 hours at the beginning may heal ERD faster than once a day injection. Although more study is still undergoing, this preliminary data indicated that if rapid healing of ERD is needed in certain patients, Protonix given through continuous IV infusion for the initial 72 hours should be considered.

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