NEW YORK (Reuters Health) – Proton pump inhibitor therapy can induce acid-related symptoms in healthy adults after drug withdrawal, according to the results of a randomized, placebo-controlled study appearing in the July issue of Gastroenterology.
“It thus seems that the drugs induce the symptoms they are used to treat, which might lead to PPI dependency,” primary author Dr. Christina Reimer, from Køge University Hospital, Denmark, told Reuters Health. “Our results justify the speculation that PPI dependency could be one of the explanations for the rapidly and continuously increasing use of PPIs.”
In the study, 120 healthy volunteers with similar baseline Gastrointestinal Symptom Rating Scale scores were randomized to 12 weeks of placebo or 8 weeks of esomeprazole (40 mg/d) followed by 4 weeks of placebo.
Dr. Reimer and colleagues report that 44% of previously asymptomatic healthy volunteers developed clinically significant heartburn, acid reflux, or dyspepsia after withdrawing from PPI therapy at week 9 to week 12, compared with 15% in the placebo group for the same time period.
“PPIs are prescribed very liberally for a number of unspecific symptoms that has probably nothing to do with gastric acid,” Dr. Reimer noted. “With this liberal prescription of drugs, we could risk inducing a true need for the drugs in patients who had no indication for therapy in the first place.”
“I think that our findings challenge this liberal prescription policy and that we as doctors need to be more restrictive in the future,” Dr. Reimer added.
The authors of an editorial on the study agree. “Efforts should be pursued to try to restrict proton-pump inhibitor therapy use to those likely to derive benefit,” write Drs. Kenneth E. L. McColl and Derek Gillen of University of Glasgow, Gardiner Institute, UK.
Additionally, they suggest that when PPIs are used as a diagnostic test for possible acid-related symptoms, “it seems to be appropriate to implement a short-course (1-2 weeks) to reduce the chance of inducing hyperacidity and associated symptoms.”
“The current study,” Drs. McColl and Gillen maintain, also challenges the increasing tendency to adopt a ‘step down’ rather than ‘step-up’ approach to the treatment of patients presenting with symptoms assumed to be from acid reflux.”
The clinicians also make the point that “the pathophysiology of acid reflux concerns the dysfunction of the gastrointestinal barrier and research needs to refocus on ways of restoring its competence rather than merely suppressing gastric acid secretion.”
Reference:
Gastroenterology 2009;137:20-22,80-87.
