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Acid Symptoms After Proton-Pump–Inhibitor Discontinuation

Healthy volunteers developed acid-related symptoms after discontinuing a PPI that they had taken for 8 weeks.

Proton-pump inhibitors (PPIs) block the secretion of gastric acid from parietal cells. As a result, serum gastrin levels rise and parietal-cell mass increases. When PPI therapy is discontinued, acid production rebounds.

To clarify the clinical significance of this rebound, investigators in Denmark randomized 120 healthy volunteers without gastrointestinal symptoms to receive either 12 weeks of placebo (control group) or 8 weeks of esomeprazole (40 mg/day) followed by 4 weeks of placebo (PPI group). Each week, participants completed the Gastrointestinal Symptom Rating Scale (GSRS) survey.

The two groups had similar baseline GSRS scores. At weeks 10, 11, and 12, the mean scores on acid-related symptoms were significantly higher in the PPI group than in the control group, and the gap between the groups widened during the course of these 3 weeks. Significantly more PPI recipients than controls (44% vs. 15%) reported heartburn, acid regurgitation, or dyspepsia during at least 1 week from weeks 9 through 12.

Comment: The data from this well-designed study suggest that discontinuation of PPI therapy results in acid-related symptoms. The findings must be confirmed in other populations, but they nonetheless have important implications, given the large number of patients without clear indications for PPI therapy who receive it long term. If a patient who does not truly need a PPI reports transient acid-related symptoms when the drug is discontinued, the treating clinician might conclude that the patient has underlying acid-related disease and resume PPI therapy unnecessarily. Future studies also ought to follow patients for longer periods to document how long post-PPI acid-related symptoms persist and, thereby, guide clinical decisions about whether to resume PPI therapy.

— David J. Bjorkman, MD, MSPH (HSA), SM (Epid.)

Published in Journal Watch Gastroenterology September 11, 2009

Citation(s):

Reimer C et al. Proton-pump inhibitor therapy induces acid-related symptoms in healthy volunteers after withdrawal of therapy. Gastroenterology 2009 Jul; 137:80. (http://dx.doi.org/10.1053/j.gastro.2009.03.058)

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• PPI Discontinuation
  Sheila A Barrett, 21 Jan 2010 6:51 PM EST
  Acidity occurred for two weeks after I stopped.