Inpatient treatment for esophagitis and gastritis?

From the Guidelines

Inpatient treatment for esophagitis and gastritis typically involves a multidisciplinary approach, with pharmacological management including proton pump inhibitors (PPIs) such as pantoprazole 40mg intravenously every 12 hours or esomeprazole 40mg intravenously every 24 hours 1.

Key Components of Treatment

• PPIs: Any PPI (dexlansoprazole, esomeprazole, lansoprazole, omeprazole, pantoprazole, or rabeprazole) may be used because absolute differences in efficacy for symptom control and tissue healing are small 1.
• Dosing: For most PPIs, dosing 30 to 60 minutes before a meal may provide optimal efficacy 1.
• Sucralfate: Patients may receive sucralfate 1g orally every 6 hours to provide mucosal protection.
• Histamine-2 receptor antagonists: Histamine-2 receptor antagonists like ranitidine 50mg intravenously every 8 hours may be used as an alternative.

Treatment Duration and Transition

• Treatment duration is usually 7-14 days, depending on the severity of symptoms and endoscopic findings, with gradual transition to oral medications and outpatient management as the patient's condition improves.
• Follow-up upper endoscopy is recommended after 8 weeks of PPI therapy for severe esophagitis to ensure healing and to rule out Barrett esophagus 1.

Important Considerations

• The use of upper endoscopy in patients with esophageal stricture secondary to GERD is largely symptom-based 1.
• In patients with a history of stricture who remain asymptomatic, routine endoscopy is not necessary 1.

From the FDA Drug Label

To evaluate the effectiveness of intravenous pantoprazole sodium as an initial treatment to suppress gastric acid secretion, two studies were conducted. Study 1 was a multicenter, double-blind, placebo-controlled, study of the pharmacodynamic effects of intravenous and oral pantoprazole sodium Patients with GERD and a history of EE (n=78,20 to 67 years; 39 females; 7 Black, 19 Hispanic, 52 White) were randomized to receive either 40 mg pantoprazole intravenously, 40 mg pantoprazole orally, or placebo once daily for 7 days. This study demonstrated that, after treatment for 7 days, patients treated with intravenous pantoprazole sodium had a significantly lower MAO and BAO than those treated with placebo (p<0. 001), and results were comparable to those of patients treated with oral pantoprazole sodium

Inpatient treatment for esophagitis and gastritis can be managed with intravenous pantoprazole sodium as an initial treatment to suppress gastric acid secretion.

• The recommended dose is 40 mg intravenously once daily.
• Studies have shown that intravenous pantoprazole sodium is effective in reducing maximum acid output (MAO) and basal acid output (BAO) in patients with GERD and a history of erosive esophagitis 2.
• Results are comparable to those of patients treated with oral pantoprazole sodium 2.

From the Research

Inpatient Treatment for Esophagitis and Gastritis

• The use of proton-pump inhibitors (PPIs) is a common treatment approach for acid-related diseases, including esophagitis and gastritis 3.
• PPIs have been shown to be effective in providing symptomatic relief in patients with gastroesophageal reflux disease (GERD) 4.
• A cost-effective analysis of PPIs in the long-term management of GERD found that on-demand PPI treatment strategy was the most effective and cost-saving approach 5.
• Pre-endoscopic PPI use may reduce the need for endoscopic haemostatic treatment at index endoscopy in patients with upper gastrointestinal bleeding 6.
• Endoscopic and histological characteristics of patients with eosinophilic esophagitis responsive and non-responsive to PPIs have been compared, with edema and vertical lines being more frequent in non-responsive patients 7.

Treatment Approaches

• PPIs are commonly used to treat esophagitis and gastritis, with rabeprazole being effective in providing quick and sustained relief for both daytime and nocturnal GERD symptoms 4.
• On-demand PPI treatment strategy has been shown to be the most effective and cost-saving approach in the long-term management of GERD 5.
• Pre-endoscopic PPI use may be beneficial in reducing the need for endoscopic haemostatic treatment at index endoscopy in patients with upper gastrointestinal bleeding 6.

Patient Characteristics

• Patients with eosinophilic esophagitis who are responsive to PPIs tend to have lower eosinophil counts in the mid-esophagus compared to non-responsive patients 7.
• Edema and vertical lines are more frequent in patients with eosinophilic esophagitis who are non-responsive to PPIs 7.