Purpose of Proton Pump Inhibitor in Colon CA

[ACCNurse2B]

Why would a patient dx'd with stage IV colon CA with bowel obstruction be placed on Protonix? CC is Abd pain, N/V r/t abd distension, ascites. Pt is NPO & recently started TPN. No h/o GERD. Any ideas?

[jrsmrs]

Pantoprazole is a gastric acid inhibitor. Does this person have an ostomy? Colonectomy? If he/she is on TPN, it's because they are not getting sufficient nutrition via the gastrointestinal system. Why might you want to decrease stomach acid in someone with these kinds of bowel concerns?

[ACCNurse2B]

No ostomy or colonectomy. I understand the use of the TPN, but I'm not sure why acid reduction would be necessary. Dyspepsia? Reduce general irritation of the GI tract since patient is not eating has nothing to counteract the pH? I'm just not sure.

[jrsmrs]

This is just my own assumption, but I would say to reduce the acid in general. No use for all that HCl when they are not eating, not having sufficient peristalsis, and could conceivably end up with irritation/ulcers of the GI tract if the stomach were allowed to produce its usual amount of acid when there is no food going through. With an ostomy, you could of course end up with more peristomal irritation if the HCl level was high.

[ACCNurse2B]

That's kinda what I was thinking. Just wanted to get a second opinion. Thanks so much for your help!

[Pharmkat]

One more assumption...

PPI's and H2 blockers always confuse me. But in response to your question, I know that the stomach has a pretty narrow ph range at which it can absorb nutrients effectivey. Ulcers are a big concern, as well, like you said. :)

[Bumashes, MSN, APRN, NP]

An oncologist I work with has told me before that there was some kind of study done on pts in ICU settings who were administered protonix (or any other PPI.) He said the result was that very few of the pts who got the protonix ended up developing ulcers and such. He said since then, everyone seems to have taken that study and stretched it to where everyone in the hospital gets a PPI. He said there has been no study on the effects it has on ulcer development anywhere but in the critical care setting, but I guess everyone figured that if it worked there then it can work anywhere.