Rebound Acid Reflux with PPIs May Induce Dependence

Steps to Limit Antacid Dependency

In an accompanying editorial, Dr. Kenneth McColl and Dr. Derek Gillen of the University of Glasgow in Scotland said the findings should challenge current "liberal" prescribing habits.

Among their recommendations:

Restrict PPI use to patients who are most likely to benefit from them, such as those with symptoms accompanied by endoscopic evidence of acid damage.

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Limit the PPI trial period to one or two weeks to reduce the chance of inducing hyperacidity and associated symptoms.

Adopt a "step-up" approach rather than "step-down" from medications to lifestyle alterations and milder medications such as antacids or alginates.

Inform patients about rebound acid hypersecretion and its potential effects as part of the discussion about side effects and safety.

To prove that the "acid rebound" symptoms were not simply a relapse of symptoms from underlying disease, Dr. Bytzer's group conducted a double-blind, placebo-controlled trial in 120 healthy volunteers without any prior acid-related disease, symptoms, or treatment.

These participants were randomly selected to receive either 12 weeks of placebo pills or eight weeks of the PPI esomeprazole followed by four weeks of placebo.

None of the symptoms reported on the Gastrointestinal Symptom Rating Scale questionnaire patients filled out each week was different between groups through week eight.

But after the PPI group discontinued therapy in week nine, their dyspepsia and reflux syndrome scores on the gastrointestinal-specific scale climbed in comparison with the placebo group.

For weeks nine through 12, the esomeprazole group reported more of the form of indigestion known as dyspepsia, as well as acid reflux. The typically mild to moderately severe reflux symptoms showed up within the first two weeks after discontinuation of esomeprazole for the majority of patients.