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Is there any benefit with pantoprazole treatment in infantile hypertrophic pyloric stenosis?
Natasha Fourie1, Marion Arnold2, Behrouz Banieghbal1
1Division of Paediatric Surgery, Tygerberg Hospital, University of Stellenbosch, Stellenbosch, South Africa.
Insights
Pre-operative intravenous pantoprazole (a proton-pump inhibitor) speeds up metabolic correction in infants with hypertrophic pyloric stenosis. This treatment also reduced post-operative vomiting and significantly improved outcomes for those with profound hypochloraemia.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Neonatal Care
Background:
- Previous research indicated intravenous histamine-2 receptor antagonists accelerate metabolic correction in hypertrophic pyloric stenosis.
- The efficacy of proton-pump inhibitors (PPIs) in this context, particularly in delayed presenters, remained less understood.
Purpose of the Study:
- To evaluate the effectiveness of pre-operative intravenous pantoprazole in correcting metabolic derangements in infants with hypertrophic pyloric stenosis.
- To compare outcomes between patients receiving pantoprazole and those who did not, including analysis of delayed presenters in a South African setting.
Main Methods:
- A 5-year retrospective review compared metabolic correction rates in two South African tertiary centers.
- One center administered IV pantoprazole (1 mg/kg daily) preoperatively; the other did not.
- Statistical analysis included Spearman's rank correlation, Student's t-test, and Fisher's exact test (P < 0.05 significant).
Main Results:
- The pantoprazole group (n=42) showed an 8-hour faster mean time to metabolic correction compared to the non-PPI group (n=24) (P=0.067).
- Pre-operative chloride administration correlated with faster metabolic correction (P < 0.0001).
- Profound hypochloraemia (<85 mmol/l) resolved 23 hours faster in the PPI group (P < 0.004), with significantly less post-operative emesis (0.45 vs 0.75 episodes/patient, P=0.01).
Conclusions:
- Pre-operative IV pantoprazole administration facilitates faster correction of metabolic derangements in hypertrophic pyloric stenosis.
- The PPI group experienced significantly reduced post-operative emesis.
- Pantoprazole demonstrated substantial benefits in correcting profound hypochloraemia, suggesting its utility in managing these pediatric surgical cases.
Context:
Previous studies demonstrated faster correction of metabolic derangement associated with hypertrophic pyloric stenosis with pre-operative intravenous (IV) histamine-2 receptor antagonists.
Aims:
We investigated if similar outcomes are achieved with IV pantoprazole, a proton-pump inhibitor (PPI), including the subgroup of delayed presenters in the South African setting.
Settings And Design:
A 5-year retrospective record review (January 2014-December 2018) compared the rate of metabolic correction in patients with hypertrophic pyloric stenosis at two tertiary centres.
Subjects And Methods:
One centre routinely administers IV pantoprazole (1 mg/kg daily) preoperatively (PPI group) and the other does not (non-PPI group). Fluid administration, chloride supplementation and post-operative emesis were evaluated.
Statistical Analysis:
Spearman's rank correlation coefficient was used to calculate statistical significance for discrete dependent variables. Continuous variables were compared between the groups using the Student t-test. Fisher's exact contingency tables were used to classify categorical data and to assess the significance of outcome between two treatment options. P < 0.05 was considered statistically significant.
Results:
Forty-two patients received IV pantoprazole and 24 did not. The mean time of metabolic correction was 8 h shorter in the PPI group (P = 0.067). Total pre-operative chloride administration correlated to the rate of metabolic correction in both cohorts (P < 0.0001). Profound hypochloraemia (chloride <85 mmol/l) was corrected 23 h faster in the PPI group (P < 0.004). Post-operative emesis was noted: 0.45 episodes/patient in the PPI group and 0.75 episodes/patient in the non-PPI group (P = 0.01).
Conclusions:
Pre-operative IV pantoprazole administration showed a faster correction of metabolic derangements, and in profound hypochloraemia, the correction occurred substantially faster in the PPI group. Post-operative emesis was significantly less frequent in the PPI group.
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