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EFFECT OF PANTOPRAZOLE AS AN ADJUNCT TO STANDARD MEDICAL THERAPY IN PATIENTS WITH UNCOMPLICATED AMOEBIC LIVER ABSCESS: A RANDOMIZED PILOT STUDY
Ramesh Kumar
*, Rishabh Patel, Sudhir Kumar, Rajeev Nayan Priyadarshi
Gastroenterology, All India Institute of Medical Sciences Patna Library, Patna, Bihar, India
Background: For decades, the first-line treatment for ALA has been metronidazole which has several drawbacks. Thioredoxin reductase enzyme of Entamoeba histolytica (EH), the causative organism of ALA, is essential for its antioxidative defence and survival during tissue invasion. Recently, benzimidazole nucleus of proton pump inhibitors has been found to inhibit the thioredoxin reductase of EH quite effectively. We conducted a randomized open-label pilot study, comparing the use of adjunct pantoprazole with standard medical therapy (SMT) in patients with uncomplicated ALA.
Methods: A total of 60 patients with uncomplicated ALA were randomized to receive either of three treatment groups: SMT as metronidazole for 10 days (group A); SMT plus pantoprazole 80 mg first dose followed by 40 mg twice daily for 10 days (group B); and SMT plus intravenous pantoprazole as 80 mg first dose followed by an infusion (8 mg/hr) for 3 days, then 40 mg BD for next 7 days (group C).
Results: Significant benefits were seen in patients who received pantoprazole (group B+C) in terms of time to resolution of fever, abdominal pain, and normalization of total leucocyte count (TLC), compared to patients who did not (group A). The group C patients demonstrated the maximum decline in the pain visual analogue pain scores from 7.50 at baseline to 3.80 at 72 hours, p = <0.001. Moreover, the time for the resolution of abdominal pain, fever and leukocytosis was lowest in the group C patients. Although proportion of patients requiring percutaneous catheter drainage (PCD) was lesser in group C, the difference was not statistically significant. The only independent predictor of PCD requirement was the presence of liquified abscess (OR: 44.8, 95% CI (11.04-250.21, p<0.001). There was no mortality in this study. The mean duration of hospitalization was the lowest for group C patients.
Conclusions: Adjunct use of PPI was found to expedite the clinical recovery of patients with uncomplicated ALA. Thus, pantoprazole can be a novel addition to the existing therapeutic armamentarium for the treatment of ALA.
Consort diagram showing screening, enrollment and allocation of treatments of patients with amoebic liver abscess (ALA). Abbreviations: PCD: percutaneous catheter drainage.
Comparison of treatment responses between different study groupsAbbreviations: SD: standard deviation; RUQ: right upper quadrant, PCD: percutaneous catheter drainage; TLC: total leukocyte count.
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