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MAXIMAL GASTRIC ACID SUPPRESSION: INTRAVENOUS (IV) VS. ORAL (PO) PANTOPRAZOLE (PAN)
F Douglas Bair, Cindy James, David Armstrong
Division of Gastroenterology, McMaster University, Hamilton, Ontario
AIM: Oral proton pump inhibitors (PPIs) aid the healing of acid-peptic lesions in most patients; IV PPIs are used if greater acid suppression is desirable. Concern that oral PPIs cannot match the acid suppression of IV PPIs may delay the switch from IV to PO PPI. We compared the acid suppression produced by comparable daily doses of IV and PO PAN (PantolocÒ, Byk Canada, Oakville) in healthy subjects.
METHODS: We used a double-blind, cross-over design of 11 healthy, fasted, H. pylori-negative (C13 UBT) subjects (mean age 22 yr.) who received (1) PO PAN (80mg then 40mg Q4H – 5 doses; 280 mg total), and (2) IV PAN (80mg bolus over 2 min. then 8mg/hr infusion for 24 hrs; 292 mg total), separated by a washout period of ³ 1 week. Gastric pH was monitored for 28 hrs with a bipolar glass pH electrode (Ingold, Canada).
RESULTS: Median 24hr gastric pH values (0-24 hrs) were not significantly different for IV PAN (3.22; IQR 2.66-3.72) and PO PAN (3.21; IQR 2.09-3.59; p>0.05 vs. IV); the mean 28-hr pH curves were comparable (Figure). Median pH values for consecutive 4-hr intervals were not different except for the period from 4-8 hrs (IV PAN 2.98 vs. PO 2.48; p = 0.05).
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