Pantoprazole taken for Barrett's esophagus results in dark stools, low back pain, etc. Kindly help.

Question

Hello doctor,

I am diagnosed with Barrett’s esophagus before few years. Endoscopy and colonoscopy found two benign, precancerous polyps. Doctor prescribed 40 mg Pantoprazole for 30 months. Since taking, I have noticed greasy, floating, dark brown stools, along with hip, gluteal, and lower back pain, occasional halitosis, gas, and stomach discomfort (nausea, dull pain) in the morning. No weight loss. Recent testing for steatorrhea, fecal elastase, ultrasound, and breath analysis are all negative. I switched to Pepcid 20 mg last week but no changes yet.

Answer 1

Hello,

Welcome to icliniq.com.

Well, your concern regarding the 30-month prescription for acid suppressant medication (commonly called proton pump inhibitor-PPI) is very much genuine. The current American Gastroenterology guidelines have not suggested a specific period when should stop PPI in a patient found to have Barrett's esophagus only without dysplasia (a pre-cancerous condition).

However, there is a guideline saying lifelong PPI if someone has a tumor or dysplasia in Barrett's and successfully treated. I do not know whether your primary gastroenterologist ever noticed dysplasia (a pre-cancerous condition) in Barrett's.

I would suggest you upload files of your endoscopy and histopathology report as it can be available to comment on that. The usual four to eight weeks of PPI are prescribed for gastroesophageal reflux (GERD) without Barrett's esophagus, not in your case.

Secondly, your symptoms of halitosis, gas, and stomach discomfort may be secondary to uncontrolled GERD. So, instead of lowering your PPI dose, I recommend optimizing the PPI dose as per your need. Maybe Pantoprazole 40 mg twice daily.

I would recommend you to take a three-week course of an antibiotic Rifaximin 200 mg thrice daily. This will help resolve your gas problem.

I hope this helps.