Inflammation of the esophagus from refluxed stomach acid can damage the lining and cause bleeding or ulcersalso

called esophagitis. Baclofen, a GABAB receptor agonist, reduces the incidence of TLESR and improves GERD symptoms 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 rst 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 re 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)

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 symptoms 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 erosive esophagitis 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 <65 years 7] Pantoprazole and Rabeprazole were significantly more effective than omeprazole in healing esophagitis and than omeprazole or lansoprazole in improving symptoms. Ref: World J Gastroenterol 2007 September 7; 13(33): 4467-4472 8]Intravenous or parenteral pantoprazole may become the preferred antisecretory agent for patients unable to take oral medications (e.g., critically ill patients and those with Zollinger-Ellison syndrome).* Ref: http://europepmc.org/abstract/MED/10665250 9] Offers High Healing Rates and Symptoms Relief in GERD within 12 weeks.*

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 signicantly efcacious 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 of i.v.famotidine.

19] ] 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.*

Domperidome: - Enhances LES tone - Facilitates gastric emptying. - Reduces Reflux of Gastric Content. - Enhances GI motility.

- Esophageal clearance.
The therapeutic goals are to control symptoms, heal Esophagitis and maintain remission so that morbidity 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

 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