Is there any Benefit with Pantoprazole Treatment in Infantile Hypertrophic Pyloric Stenosis?

Context: Previous studies demonstrated faster correction of metabolic derangement associated with hypertrophic pyloric stenosis with pre-operative intravenous (IV) histamine-2 receptor antagonists. Aims: We investigated if similar outcomes are achieved with IV pantoprazole, a proton‑pump inhibitor (PPI), including the subgroup of delayed presenters in the South African setting. Settings and Design: A 5‑year retrospective record review (January 2014–December 2018) compared the rate of metabolic correction in patients with hypertrophic pyloric stenosis at two tertiary centres. Subjects and Methods: One centre routinely administers IV pantoprazole (1 mg/kg daily) preoperatively (PPI group) and the other does not (non‑PPI group). Fluid administration, chloride supplementation and post‑operative emesis were evaluated. Statistical Analysis: Spearman’s rank correlation coefficient was used to calculate statistical significance for discrete dependent variables. Continuous variables were compared between the groups using the Student t‑test. Fisher’s exact contingency tables were used to classify categorical data and to assess the significance of outcome between two treatment options. P < 0.05 was considered statistically significant. Results: Forty‑two patients received IV pantoprazole and 24 did not. The mean time of metabolic correction was 8 h shorter in the PPI group (P = 0.067). Total pre‑operative chloride administration correlated to the rate of metabolic correction in both cohorts (P < 0.0001). Profound hypochloraemia (chloride