Acid-reducing medicines may lead to dependency

NEW YORK Treatment with proton-pump inhibitors could have the opposite of the intended effect in healthy people, according to a new study in Gastroenterology, the official journal of the American Gastroenterological Association Institute.

Researchers studied the effects of PPIs for eight weeks, finding that instead of reducing such acid-related symptoms as heartburn, acid regurgitation and dyspepsia post-treatment, the symptoms returned once the therapy ended.

"This study indicates unrecognized aspects of PPI withdrawal and is a very strong indication of a clinically significant acid rebound phenomenon that needs to be investigated in proper patient populations,” said Christina Reimer, MD, of Copenhagen University and lead author of the study.

According to earlier studies, 33% of patients who initiate PPI treatment continue to refill their prescriptions without an obvious indication for maintenance therapy. Rebound acid hypersecretion, defined as an increase in gastric acid secretion above pre-treatment levels following antisecretory therapy, is observed within two weeks after withdrawal of treatment and could theoretically lead to such acid-related symptoms as heartburn, acid regurgitation or dyspepsia that might result in resumption of therapy.

Data showed 44% of those randomized to PPIs reported at least one relevant acid-related symptom compared to 15% in the placebo group.

"We find it highly likely that the symptoms observed in this trial are caused by rebound acid hypersecretion and that this phenomenon is equally relevant in patients treated long term with PPIs. If rebound acid hypersecretion induces acid-related symptoms, this might lead to PPI dependency. Our results justify the speculation that PPI dependency could be one of the explanations for the rapidly and continuously increasing use of PPIs," said Reimer.