R E V I E W Long-term management of GERD in the elderly with pantoprazole Carlo Calabrese Anna Fabbri Giulio Di Febo Department of Internal Medicine and Gastroenterology, University of Bologna, Italy Correspondence: Carlo Calabrese Dipartimento di Medicina Interna e Gastroenterologia, Policlinico S. Orsola Malpighi,Via Massarenti n. 9, 40138 Bologna, Italy Tel +39 051 636 4191 Fax +39 051 636 4138 Email calabrese.c@med.unibo.it Abstract: The prevalence of gastroesophageal reﬂux disease (GERD) increases with age and elderly are more likely to develop severe disease. Older patients often complain of less severe or frequent heartburn than younger patients and they may present with atypical symptoms such as dysphagia, weight loss, or extraesophageal symptoms. Proton pump inhibitors (PPIs) are central in the management of GERD and are unchallenged with regards to their efﬁcacy. They are considered safe and more effective than histamine receptor antagonists for healing esophagitis and for preventing its recurrence using a long term maintenance treatment. PPI have minimal side effects and few slight drug interactions and are considered safe for long term treatment. Pantoprazole is signiﬁcantly effective both for acute and long-term treatment with excellent control of relapse and symptoms. It is well tolerated even for long-term therapy and its tolerability is optimal. Pantoprazole shows to have minimal interactions with other drugs because of a lower afﬁnity for cytocrome P450 than older PPIs. Although the majority of elderly has concomitant illnesses and receive other drugs, this does not adversely effect the efﬁcacy of pantoprazole because of its pharmacokinetics, which are independent of patient age. Clinical practice suggests that a low dose maintenance of PPIs should be used in older patients with GERD. Keywords: GERD, long-term management, pantoprazole, safety, efﬁcacy, tolerability Introduction The reﬂux of gastric contents from the stomach into esophagus is well recognized to play a major role in the pathogenesis of gastroesophageal reﬂux disease (GERD). Signiﬁcant information has accumulated over the past decade to support the position that the proton pump inhibitors (PPIs) represent powerful drugs that are especially effective in the treatment of GERD. These drugs inhibit the ﬁnal common pathway to acid secretion, the H+/K+ ATPase located in the secretory canalicular membrane of the gastric parietal cell (Sachs et al 1993). In addition a long acting inhibition of gastric acid secretion occurs because of the covalent bonds formed by PPIs with the H+/K+ ATPase (Shin and Sachs 2002). As a consequence of their ability to signiﬁcantly suppress acid secretion, PPIs are the preferred class of therapeutic agents for the treatment of GERD. Symptom relief and acute healing of esophageal lesions can be achieved with short-term treatment. It has been demonstrated that healing regards not only erosive esophagitis but also negative endoscopy esophagitis (NERD) at the ultrastructural view of the mucosa (Calabrese, Bortolotti, et al 2005). Otherwise, GERD is a chronic relapsing disease requiring long-term therapy in most patients. The high prevalence of chronic discomfort, which may or may not be associated with macroscopic esophagitis or related complications, decreases the patient’s quality of life, increases the need for physician of visits and hospitalizations, and is costly for society. Most GERD patients require long term treatment to remain Clinical Interventions in Aging 2007:2(1) 85–92 © 2007 Dove Medical Press Limited.All rights reserved 85