What is Pantoprazole?

Pantoprazole sodium (brand name Protonix) belongs to a group of drugs called proton pump inhibitors (PPIs). These drugs are used to reduce gastric acid production. Examples of PPIs include:

Dexlansoprazole (Dexilant)
Esomeprazole (Nexium)
Lansoprazole (Prevacid)
Omeprazole (Prilosec)
Omeprazole with sodium bicarbonate (Zegerid)
Pantoprazole (Protonix)
Rabeprazole (AcipHex)

Uses of Pantoprazole

Pantoprazole is used to treat conditions causing too much stomach acid, such as heartburn, reflux disease, and gastroesophageal reflux disease (GERD), the chronic form of acid reflux.

Acid reflux happens when stomach acid backflows into the esophagus (food pipe) and throat.

Pantoprazole is also used to heal erosive esophagitis and prevent further damage to the esophagus in people with GERD.

Another clinical indication (approved use) of pantoprazole is the treatment of Zollinger-Ellison syndrome, a rare digestive disorder in which there is excessive gastric acid secretion due to tumors in the pancreas or small intestine.

How it is Used For Crohn's Disease?

Pantoprazole is not generally used for Crohn’s disease. In fact, meta-analysis and systematic reviews of observational studies and cohort studies have shown that proton pump inhibitor use can increase the risk of developing Crohn’s disease and lead to worse outcomes in people with pre-existing inflammatory bowel disease.

What is Crohn’s Disease?

Crohn’s disease is a lifelong autoimmune disease in which there is inflammation (irritation and swelling) of the digestive tract, causing abdominal pain, diarrhea, and other symptoms. While Crohn’s disease can cause inflammation in any part of the digestive tract, from the mouth to the anus, the ileum (the lower part of the small intestine) and colon (the beginning part of the large intestine) are the most commonly affected areas.

Crohn’s disease is a type of inflammatory bowel disease (IBD). The other type of inflammatory bowel disease (IBD) is called ulcerative colitis, and it causes inflammation in the colon (large intestine) and rectum.

What Causes Crohn’s Disease?

Crohn’s disease does not have a single known cause, but it is thought to be linked to a malfunctioning immune response. Typically, the immune system targets only foreign and harmful substances. However, in the case of autoimmune conditions, the immune system mistakenly attacks the body’s own healthy tissues, cells, or organs.

In Crohn’s disease, the immune system erroneously attacks the beneficial bacteria that normally reside in the gut. These gut bacteria are crucial for maintaining proper gut function, as they help break down food and support the body’s immune system.

A meta-analysis reviewing the results of 17 studies shows that there is an association between multiple sclerosis and IBD. Notably, another study found that rheumatoid arthritis is associated with an increased risk of IBD, but not the other way around; meaning having IBD is not a risk factor for developing rheumatoid arthritis (RA).

In addition to an abnormal immune response, scientists believe that several factors can contribute to the development of Crohn’s disease.

Genes—Crohn’s disease can sometimes run in families. If you have a family member with Crohn’s, your risk of developing the condition may be higher. However, it’s important to note that many people with Crohn’s disease do not have any other family members affected by the condition.
Environments—Experts suggest that various environmental factors play a significant role in influencing a person's immune system, genetics, and gut microbiome, which can ultimately affect the likelihood of developing Crohn's disease. Two notable environmental factors are smoking and an individual's place of residence. Research indicates that smoking may double the risk of developing Crohn's disease while living in developed countries or urban areas can also increase this risk. Conversely, residing in more rural areas may reduce the likelihood of developing the disease.
Age—Crohn’s disease can occur at any age, but many cases occur during the late teens through early 30s.

Symptoms of Crohn’s Disease

Symptoms of inflammatory bowel disease include

Stomach pain
Stomach cramping
Severe diarrhea
Blood in stool
Decreased appetite
Weight loss
Malnutrition
Mouth sores
Fever
Fatigue
Pain or drainage from the anus due to fistula formation
Growth retardation in children with pediatric IBD

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Treatment Options for Crohn’s Disease

There is no cure for Crohn’s disease. However, treatment of Crohn’s disease can help to manage symptoms and improve quality of life. Some of the common treatments prescribed to Crohn’s disease patients include:

Anti-Inflammatory Drugs

Corticosteroids can be used for 3-4 months to control inflammation related to IBD. Sometimes, steroid medicines are given intravenously in the hospital. However, corticosteroids don’t help in reducing inflammation in everyone with Crohn’s disease and they cannot be used long-term. Examples include prednisone, methylprednisolone, and budesonide (Entocort EC).
5-aminosalicylates (5-ASAs) are used to treat mild to moderate Crohn's disease. They work best for IBD involving the colon (large intestine) and are less effective in controlling inflammation in the small intestine. Examples include sulfasalazine (Azulfidine) and mesalamine (Pentasa, Delzicol).

Immune System Suppressors

Immunosuppressors target the immune system and prevent the release of substances that cause inflammation. People taking immune system suppressors require close follow-up and regular blood tests. Examples include:

Biologic Drugs

Biologics are drugs that target immune system proteins and interrupt the inflammatory process. Examples of biologic drugs used for the treatment of Crohn's disease include:

TNF inhibitors: These drugs block the effects of a protein called tumor necrosis factor (TNF), for example, infliximab (Remicade), adalimumab (Humira), and certolizumab pegol (Cimzia).
Interleukin inhibitors: These drugs interrupt the action of a protein called interleukin that plays a role in inflammation. For example, ustekinumab (Stelara).
Monoclonal antibodies: These drugs stop immune molecules called integrins from binding to cells lining the intestines. For example, vedolizumab (Entyvio), which is a gut-specific monoclonal antibody approved for the treatment of Crohn's disease. Another monoclonal antibody, risankizumab (Skyrizi) binds to interleukin-23 and is approved for use in people with moderate to severe Crohn's disease.

Note: Biosimilars are synthetic versions of biologic drugs that are similar to the original drugs but may cost less.

Janus Kinase (JAK) Inhibitors

Also called small molecules, JAK inhibitors are a group of newer oral medicines for Crohn’s disease that did not respond to other treatments. JAK inhibitors work by targeting the immune system to reduce inflammation. Upadacitinib was approved by the U.S. Food and Drug Administration (FDA) as the only JAK inhibitor for Crohn’s disease.

Antibiotics

People with Crohn’s disease are sometimes prescribed antibiotics such as ciprofloxacin (Cipro) and metronidazole (Flagyl) for an infection or to reduce drainage from a fistula or abscess. There is also some evidence that antibiotics may reduce harmful bacteria in the gut microbiota that could be triggering inflammation.

Other Medications for Crohn’s Disease

Doctors may prescribe a variety of medications for symptom relief from Crohn's disease. Some of these medicines are available over-the-counter. However, if you have Crohn’s disease, it is best to check with your healthcare provider before taking any medicine.

Anti-diarrheals: Fiber supplements such as methylcellulose (Citrucel) and psyllium husk (Metamucil) add bulk to stool and can be used to manage mild diarrhea. Doctors sometimes prescribe loperamide (Imodium A-D) for severe diarrhea.
Pain medicines: Acetaminophen (Tylenol) is recommended for pain relief. However, people with inflammatory bowel disease should not take nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Motrin IB, Advil) or naproxen sodium (Naprosyn, Aleve). NSAIDs can make IBD symptoms worse and cause worsening inflammation.
Dietary supplements: Many people with Crohn’s disease have nutritional deficiencies because they don’t absorb vitamins and minerals properly. Your healthcare provider may recommend taking dietary supplements for this reason.

Nutrition Therapy

Some people with Crohn’s disease require nutrition through a feeding tube (this is called enteral nutrition) or a vein (this is called parenteral nutrition). The goal is to allow bowel rest, which may help with short-term control of inflammation. Nutrition therapy may be used when other medicines do not control symptoms or to get a patient healthier before surgery.

Dietary Modifications

Healthcare professionals sometimes recommend a low-fiber diet to people with Crohn’s disease. This is to lower the risk of intestinal blockage if there is a stricture (narrowing) in your bowel.

Surgery for Crohn’s Disease

Approximately 50% of Crohn’s disease patients require at least one surgery in their lifetime. Surgery does not cure the condition, but the removal of the damaged bowel can help improve symptoms. However, recurrence of Crohn’s near the reconnected healthy parts of the bowel is common, and it is a temporary solution. Surgery, followed by medical management, usually helps.

In addition, surgery is sometimes necessary to drain abscesses or close fistulas (abnormal connections between parts of the digestive tract).

Diagnosing Crohn's Disease

Crohn’s disease can affect any part of the gastrointestinal tract, from the mouth to the anus. The symptoms of Crohn’s disease can vary greatly from person to person, depending on the severity of the inflammation and associated complications, such as abscesses, fistulas, and strictures. There is no standard process for diagnosing and treating Crohn’s disease. As a result, it is common for patients to have symptoms for years prior to receiving a Crohn’s disease diagnosis.

Pantoprazole For Crohn's Disease Treatment

There is no evidence supporting the use of pantoprazole in patients with inflammatory bowel disease. Pantoprazole is a proton pump inhibitor (PPI). PPI indications (uses) are conditions in which there is excessive gastric acid production. In fact, there is evidence that shows taking a PPI may put you at an increased risk for IBD.

However, doctors sometimes give a PPI prescription alongside steroid medicines. This is to lower the risk of steroid side effects like indigestion, peptic ulcer formation, and GI bleeding.

Note: Pantoprazole use is not recommended in patients with microscopic colitis (a type of IBD that affects the large intestine). Also, patients taking immunosuppressants such as tacrolimus or methotrexate should not take pantoprazole.

What Are the Risks of Taking Pantoprazole For Crohn’s Disease?

Studies have found that proton pump inhibitors (PPIs) affect the disease process in inflammatory bowel disease in many ways.

Proton pump inhibitors (PPIs) including pantoprazole are commonly used to treat acid reflux (GERD). However, PPI use in patients with Crohn’s disease and ulcerative colitis (inflammatory bowel disease) may result in a higher risk of disease complications. There are effective treatment options available for Crohn’s disease (see above).

How Pantoprazole Effects Gut Health

Some of the underlying mechanisms by which pantoprazole affects gut health include:

Gut Microbiome

Several studies, including the Nurses Health Study, have found links between PPI use and an increased risk of developing inflammatory bowel disease. Scientists believe this is because PPI users have disruptions in their gut microbiota (balance between beneficial and harmful gut bacteria). This can increase the risk of intestinal infections, which can trigger the development of IBD.

Gut Health and Crohn's Disease

Studies have demonstrated that proton pump inhibitors can increase the permeability of the intestinal mucosa. In other words, these drugs may make the intestinal mucosal barrier (the protective inner lining of the intestines) more porous, allowing certain bacteria to grow. This can increase the risk of gastrointestinal infections, which can lead to inflammation and IBD.

PPIs and the Immune System

Additionally, researchers have found that PPIs affect the function of immune system cells and reduce bactericidal activity (ability to kill bacteria). This might play a role in increasing the risk of IBD in people treated with proton pump inhibitors.

PPIs and IBD Disease Severity

Results of studies regarding the effect of PPIs on IBD severity are mixed. Many observational studies have found that the use of PPIs can alter the course of the disease in patients with inflammatory bowel disease and result in increased disease severity and decreased remission rates. One large study found PPIs were linked to an increased risk of IBD-related hospitalization or surgery in patients with ulcerative colitis and Crohn’s disease. In addition, research indicates that IBD patients with PPI use are more likely to require treatment escalation (have a new biologic medication started).

However, other clinical trials and studies have found no significant link between proton pump inhibitor use and severe events (hospitalization/surgery) in patients with IBD.

PPI Drug Interactions with IBD Medicines

Scientists have also found that proton pump inhibitors can decrease the effectiveness of IBD drugs, especially in older adults. For example, studies have shown that infliximab therapy is less likely to induce remission in IBD patients taking a PPI compared to patients in the control group who are not on a PPI.

PPIs decrease gastric acid secretion and increase gastric pH. This can prevent IBD drugs such as mesalazine and other therapies from reaching the colon. PPIs can also increase absorption and blood levels of certain drugs, increasing the risk of side effects.

Studies On Long-Term Use of PPIs

Long-term use of proton pump inhibitors (PPIs) is linked to a number of health complications, including:

Decreased calcium absorption and increased risk of fractures.
Low magnesium levels.
Vitamin B12 deficiency and cognitive decline.
Other nutritional deficiencies, such as folic acid, vitamin C, vitamin D, and iron.
Clostridium difficile-associated diarrhea.
Community-acquired pneumonia.
Dementia.
Kidney problems (chronic kidney disease).

Frequently Asked Questions

What Is The Drug of Choice For Crohn's Disease?

The drug of choice for Crohn’s disease depends on the severity of the disease and specific symptoms. For mild to moderate Crohn’s disease, a healthcare provider may prescribe anti-inflammatory drugs such as steroids and 5-ASAs. For moderate to severe Crohn’s disease, treatment options include biologic drugs and JAK inhibitors. In addition, doctors prescribe medicines to manage Crohn’s symptoms, such as anti-diarrhea medicines and pain relievers.

Is Pantoprazole Used For Stomach Inflammation?

Pantoprazole may be used to treat stomach inflammation (gastritis). It prevents gastric acid production and can help with healing of the stomach lining.

What Medication Is Used To Maintain Crohn's Disease?

5-aminosalicylates (5-ASAs), such as sulfasalazine (Azulfidine) and mesalamine (Pentasa, Delzicol), are commonly used for the maintenance treatment of mild to moderate Crohn's disease.

What Medications Should Be Avoided With Crohn's Disease?

Medications called nonsteroidal anti-inflammatory drugs (NSAIDs) should be avoided with Crohn’s disease. NSAIDs can increase the risk of Crohn’s flare-ups. Examples of NSAIDs include ibuprofen and naproxen. In addition, avoid any medications that have caused allergic reactions in the past.

What Disease Is Pantoprazole Used For?

Pantoprazole (Protonix) is used to treat gastroesophageal reflux disease (GERD), erosive esophagitis, and Zolinger-Ellison syndrome.

What Is The Best Pain Relief For Crohn's Disease?

The best pain relief for Crohn’s disease is acetaminophen (Tylenol). People with inflammatory bowel disease should avoid over-the-counter pain relievers like ibuprofen and naproxen as they can cause worsening symptoms of Crohn’s.

Is Pantoprazole Good For IBS?

Pantoprazole has been found to benefit patients with IBS (irritable bowel syndrome). However, most studies have looked at the effectiveness of pantoprazole and other PPIs in patients with comorbidities of both GERD and IBS. In other words, you may find pantoprazole particularly effective if you have irritable bowel syndrome and acid reflux. However, there may be other more effective medicines if you have IBS alone.

Is There A Pill Form Medication For Crohn's Disease?

There are several medications for Crohn’s disease that come in pill (tablet) form, including corticosteroids, 5-ASAs, immunosuppressants, JAK inhibitors, anti-diarrhea medicines, and pain relievers.

Summary of Key Points

Pantoprazole belongs to a group of drugs called proton pump inhibitors (PPIs).
PPIs are commonly used to treat acid reflux, erosive esophagitis, and other conditions in which there is excessive gastric acid production.
Crohn’s disease is a type of inflammatory bowel disease (IBD) in which inflammation can occur in any part of the digestive tract.
Proton pump inhibitors, including pantoprazole, are not usually prescribed to people with Crohn’s disease.
There is evidence that PPI exposure can increase IBD risk and cause worsening of Crohn’s disease symptoms.
However, PPIs are sometimes used alongside anti-inflammatory drugs like corticosteroids in people with Crohn’s disease to reduce risk factors like indigestion and bleeding.

Loperamide

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