Long Term Concerns with Pantoprazole Usage

Medical Q&A [Moderated]
1

Good morning, Docs.

Back in January I had an EGD performed. I presented with chronic GERD symptoms that I experienced for ~6 months. It had been episodic prior to this, that I would treat with OTC medicines. GI doctor was concerned that because of my age/race/symptoms that I could be at risk for Barrett’s Esophagus. EGD results showed NO Barrett’s (fortunately) just some gastritis and esophagitis. I was prescribed pantoprazole 40mg/day for 12 weeks. My symptoms went away immediately (within 1 week) of taking the PPI and remained absent during the entire 12 weeks. I could eat foods (spicy foods, coffee, carbonation) without moderation that had bothered me for years. After the 12 week prescribed treatment, I noticed the symptoms slowly coming back - even with trying to avoid trigger foods. Symptoms were not as severe as they were when I presented to GI doc initially, but they were not absent as they were while I was on the pantoprazole.

Follow up visit with GI, the doctor recommended going back on the pantoprazole. I voiced my concerns with long-term side effects (calcium/magnesium malabsorption, CVD, Renal Disease, etc.). His response was “you either take the PPIs to prevent Barrett’s or you have to take them treat Barrett’s. You are welcome to try taking the 40mg of pantoprazole every other day and see if it still manages your symptoms”

My questions to you are:

1.) Is it possible that every other day administering of pantoprazole could be an effective treatment?
2.) Are my concerns for long-term side effects warranted, or are my concerns based on faulty data?
3.) My waist at the umbilicus is 38", so I could stand to lose a few pounds. Could losing this weight reduce or eliminate my symptoms all together?

Personal Notes:
Male/White/43yrs old. I am on no other medications, train 7 days per week (4-5 sessions resistance and 2-3 cardio).

TL;DR

Pantoprazole completely alleviates my GERD symptoms and I’m prescribed to go on them long-term. Should I be concerned with long-term side effects if I don’t have any other health issues?

2

It could be. Or you could go down to 20 mg per day and see if that’s sufficient. Pantoprazole is the PPI with the least potency compared with others, so theoretically would have the lowest risk among them for longer-term adverse effects.

They are not necessarily based on faulty data, however most of these adverse effects are relatively uncommon, and again I would expect them to occur more often at higher doses of higher-potency PPIs (like Rabeprazole or Esomeprazole), although I don’t have direct evidence on this. I also suspect such adverse effects are more common in patients with other comorbid diseases, and/or with the use of other medications. If you have concerns about the potential long-term side effect profile of PPIs, you could consider using an H2 blocker instead.

It might, yes.

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3

Thank you for the response, Austin. Would a 20mg / day dose be more effective or optimal delivery than 40mg every other day?

4

I don’t know. The duration of action for pantoprazole is about 24 hours. If it were me, I would probably see if I could achieve symptom control with 20 mg daily, and if so, you may even be able to go down to 20 mg every other day. This way you can find the lowest dose necessary to control symptoms.

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