Acid-reducing Medicines May Lead To Dependency

Treatment with proton pump inhibitors (PPIs) for eight weeks induces acid-related symptoms like heartburn, acid regurgitation and dyspepsia once treatment is withdrawn in healthy individuals, according to a new study in Gastroenterology, the official journal of the American Gastroenterological Association (AGA) Institute.

"The observation that more than 40 percent of healthy volunteers, who have never been bothered by heartburn, acid regurgitation or dyspepsia, develop such symptoms in the weeks after cessation of PPIs is remarkable and has potentially important clinical and economic implications," said Christina Reimer, MD, of Copenhagen University and lead author of the study. "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."

The use of PPIs for acid-related symptoms and disorders is extensive and rapidly escalating. While the incidence of new patients being treated with PPIs remains stable, the prevalence of long-term treatment is rising, the reasons for which are not fully known. Studies have shown that up to 33 percent 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 acid-related symptoms such as heartburn, acid regurgitation or dyspepsia that might result in resumption of therapy.

"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," Dr. Reimer added.

Bonnie - I disagree with the authors. Of course this will happen. When you continually block the production of stomach acid, your body becomes more efficient in producing it. So when you stop the PPI, you will overproduce acid for a period of time. This is why people who want to stop these meds must slowly wean off them.