Comorbid patient with gastroesophageal reflux disease: Features of the choice of proton pump inhibitor

The high prevalence of gastroesophageal reflux disease (GERD) and ageing of the population makes the issue of GERD pharmacotherapy a challenge for a comorbid patient, taking into account the choice of an effective proton pump inhibitor (PPI) that has a stable and long-term acid suppression, metabolic neutrality and a low risk of drug interactions. The combination of classic esophageal manifestations of GERD, such as heartburn and regurgitation with extraesophageal manifestations due to high gastroesophageal reflux resulting in the development of ENT and respiratory symptoms, contributes to the complexity of issues of differential diagnosis and pharmacotherapy. The occurrence of chest pain and heart rhythm disturbances in a patient with GERD requires differentiation from cardiovascular diseases and the choice of therapy affecting all pathogenetic components in the context of comorbidity. Proton pump inhibitors as the mainstay of pharmacological acid suppression in GERD treatment regimens should be prescribed as the primary therapeutic course and part of maintenance therapy regimens, the duration of which is determined on a patient-by-patient basis and often amounts to years of use, which should take into account not only the effectiveness, but also the safety of a particular drug. Pantoprazole is a selective PPI for the gastric parietal cells, in which the pH reaches the lowest values, provides a long-term acid-reducing effect and is metabolically neutral when administered together with other drugs in comorbid patients. Evaluation of the safety of long-term use of the drug for up to 15 years based on the results of clinical studies showed the absence of a risk of malignant neoplasms. Moderate hypergastrinemia was not accompanied by clinically significant changes in the mucous membrane throughout the entire period of pantoprazole therapy. In conclusion, daily maintenance therapy with pantoprazole for up to 15 years is effective, well tolerated and does not raise safety concerns.