Intravenous pantoprazole rapidly controls gastric acid hypersecretion in patients with Zollinger-Ellison syndrome

Background Be Aims: Parenteral control of gastric acid hypersecretion in co nditions such as Zollinger-Ellison syndrome (ZES) or idiopathic gastric aci d hypersecretion is necessary perioperatively or when oral medications cann ot be taken for other reasons (e.g., during chemotherapy, acute upper gastr ointestinal bleeding, or in intensive care unit settings). Methods: We eval uated the efficacy and safety of 15-minute infusions of the proton pump inh ibitor pantoprazole (80-120 mg every 8-12 hours) in controlling acid output for up to 7 days. Effective control was defined as acid output > 10 millie quivalents per hour (mEq/h) (<5 mEq/h in patients with prior acid-reducing surgery) for 24 hours. Results: The 21 patients enrolled had a mean age of 51.9 years (range, 29-75) and a mean disease duration of 8.1 years (range, <0.5-21); 13 were male, 7 had multiple endocrine neoplasia syndrome type 1, 4 had undergone acid-reducing surgery, 2 had received chemotherapy, and 13 had undergone gastrinoma resections without cure. Basal acid output (mean +/- SD) was 40.2 +/- 27.9 mEq/h (range, 11.2-117.9), In all patients, acid output was controlled within the first hour (mean onset of effective contro l, 41 minutes) after an initial 80-mg intravenous pantoprazole dose. Pantop razole, 80 mg every 12 hours, was effective in 17 of 21 patients (81%) for up to 7 days. Four patients required upward dose titration, 2 required 120 mg pantoprazole every 12 hours, and 2 required 80 mg every 8 hours. At stud y end, acid output remained controlled for 6 hours beyond the next expected dose in 71% of patients (n = 15); mean acid output increased to 4.0 mEq/h (range, 0-9.7), No serious or unexpected adverse events were observed. Conc lusions: Intravenous pantoprazole, 160-240 mg/day administered in divided d oses 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.