A randomized controlled trial of adding intravenous pantoprazole to conventional treatment for the immediate relief of dyspeptic pain☆
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Fig. 1
The CONSORT diagram shows the serial case numbers of the 2 treatment groups during the study period. Notes: ∗ included patients with systemic infection (n = 1), appendicitis (n = 1) and suspected pyloric stenosis (n = 1). ∗∗ included a patient whose her treatment allocation was accidentally revealed to the investigators (n = 1).
Fig. 2
The line graph demonstrates the mean VAS scores over time after treatment in both treatment groups. (Note: error bars represent ± 2 SD).
Abstract
Introduction
Acute, severe dyspeptic pain is a common condition in the emergency department. Despite the traditional “GI cocktail” (GI indicates gastrointestinal), an intravenous (IV) proton pump inhibitor (PPI), a novel acid-lowering drug, has recently been used to treat this condition. The aim of this study was to evaluate the immediate effect of IV pantoprazole in addition to the conventional GI cocktail in the relief of severe dyspeptic pain.
Methods
This double-blind, randomized, controlled study was conducted in the emergency department of an urban tertiary-care hospital from January 2011 to October 2011. Selected patients with severe dyspeptic pain were randomized to treatment with a placebo, antacid, and antispasmodic (conventional group) or IV pantoprazole, antacid, and antispasmodic (pantoprazole group). The self-reported 100-mm visual analog scale score, adverse effects, and overall satisfaction were evaluated in 15-minute intervals for 60 minutes.
Results
Eighty-seven eligible cases were enrolled in the study. Forty-four and 43 patients were randomized in the conventional group and pantoprazole group, respectively. There was no difference in the mean 60-minute visual analog scale scores between the treatment groups. The rate of “responders,” additional drug use, adverse effects, and patient satisfaction were similar between the groups.
Conclusion
Intravenous PPI provides no additional benefit over the conventional GI cocktail in the relief of acute, severe dyspeptic pain. Because of its neutral effect and higher cost, the use of IV PPI to treat such conditions should be discouraged in general clinical practice.
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☆Conflict of interest: M.K. received one third of the total amount of intravenous pantoprazole from Merck Sharp & Dohme. The company did not provide other forms of financial support to the study and was not involved in any part of the study design, patient enrollment, data collection and analysis, or manuscript drafting. The authors declared no conflicts of interest. This study was funded by Rachadapiseksompoch Fund Grant No. RA6/54(1), Faculty of Medicine, Chulalongkorn University.
