Gastric Rebound in patients after stopping PPI therapy.

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Gastricman
Regular Member


Date Joined Jan 2013
Total Posts : 294
   Posted 2/8/2013 1:50 PM (GMT -6)   
Hi all,
 
A great question was raised by a forum member about discontinuation of PPI therapy and Gastric Rebound:
 
When going for a Ph/Impedence study off PPI's how do you know that the test isn't measuring just rebound?
 
Well, I made a call to a couple of reputable medical people in the know and I was told by the 2nd week off PPI therapy that the great percentage of patients will have ceased having any rebound. One caveat is that your MD's interpretation of the Ph/Impedence Study must also consider Gastric Rebound in the final analysis of the testing data.
 
Here is an excerpt from an article. Hope that this tries to answer the question.
 
Proton-Pump Inhibitor Therapy Induces Acid-Related Symptoms in Healthy Volunteers After Withdrawal of Therapy. - GASTROENTEROLOGY 2009;137:80–87

"Treatment with PPIs is initiated mainly by primary
care physicians, usually as empirical therapy for dyspeptic
symptoms. Empirical PPI therapy for 4 weeks in patients
with uninvestigated dyspepsia is supported by dyspepsia
guidelines. Continuous PPI therapy is indicated
in cases of severe gastroesophageal reflux disease or as
prophylactic therapy for patients who must continue
treatment with nonsteroidal anti-inflammatory drugs.

However, studies have shown that up to 33% of patients
who initiate PPI treatment redeem repeated prescriptions
without an obvious indication for maintenance therapy.
Moreover, studies have shown that primary care
physicians perceive withdrawal or reduction of long-term
PPI treatment as difficult to achieve.

Recurrence of symptoms of underlying acid-related disease is an obvious
explanation for reuptake of PPI therapy, but physiologic
changes triggered by the PPI treatment itself,
which set off once therapy is withdrawn, could hypothetically
lead to aggravation of symptoms or maybe even to
new onset of acid-related symptoms. This latter hypothesis
is supported by physiologic studies that have implied
that treatment with a PPI for 8 weeks leads to a temporarily
increased capacity to secrete acid after discontinuation
of treatment in particular in Helicobacter pylorinegative
individuals.

Rebound acid hypersecretion (RAHS), defined as an increase in gastric acid secretion
above pretreatment levels after antisecretory therapy, is
observed within 2 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.

A plausible physiologic theory for the rebound phenomenon suggests
that long-term, elevated gastric pH caused by blockage of
the proton-pumps stimulates compensatory gastrin release.
This in turn induces a hypersecretory state."

In my case, the Gastric Rebound lasted for around 5 days or so when stopping a high dose PPI daily for 5 years.

Regards,

Gastricman :-)

Post Edited (Gastricman) : 2/8/2013 1:35:49 PM (GMT-7)


sunbeam48
Veteran Member


Date Joined Jun 2011
Total Posts : 795
   Posted 2/8/2013 3:33 PM (GMT -6)   
Thanks, Gastricman, I posed this question. My rebound lasted a couple of weeks, and I am so relieved to be off PPI'S. I am gradually getting my health back now that I am off the meds and following Fast Tract diet.

dencha
Forum Moderator


Date Joined Feb 2009
Total Posts : 7181
   Posted 2/8/2013 6:45 PM (GMT -6)   
Gastricman,
I will just add this.  After my Nissen, I was tested once more with a 24hr PH monitor.  I was still taking PPIs because my asthma doc has requested I continue as a proactive measure to ensure that even a little reflux doesn't hit the lungs. 
 
Once I'd had the surgery, even during that "rebound" period, I had no pain or heartburn symptoms off PPIs.  During the 24 hr test I had none of that horrible discomfort I remembered from the two other times I'd had it.
 
I guess I'd say this...if you're getting reflux from rebound, it's still reflux.  If it's getting past the LES, no matter what the cause, it's still reflux.  I'm not sure how important it is whether or not it's measuring rebound or ordinary reflux.  The test is showing whether or not acid is getting into the esophagus.
 
Just a thought...
Denise
 
 
GERD/Heartburn Moderator
Nissen Fundoplication 2/09
Allergy/Asthma

"Whatever you fight, you strengthen, and what you resist, persists.”

“Worry pretends to be necessary but serves no useful purpose”

“Accept - then act. Whatever the present moment contains, accept it as if you had chosen it. Always work with it, not against it.”
Eckhart Tolle

sunbeam48
Veteran Member


Date Joined Jun 2011
Total Posts : 795
   Posted 2/8/2013 7:08 PM (GMT -6)   
Denise, I would think the cause does matter if you are getting testing done to see if you need surgery. If the cause of your reflux is just PPI rebound, you don't need surgery. You just need to stay off the PPI.

dencha
Forum Moderator


Date Joined Feb 2009
Total Posts : 7181
   Posted 2/8/2013 9:05 PM (GMT -6)   
Sunbeam,
From my experience, it's not so much what's getting into the esophagus, but how.  If the LES is sufficient and working, there will not be a significant amount of reflux escaping, no matter what the cause.
 
Of course ideally a test will be measuring non-rebound reflux, which is why GI docs request a significant amount of time off PPIs before the test begins. 
 
Believe me, a Nissen is not lightly recommended, and it is not needed because of PPI use.  Many avoid Nissens because PPIs work for them.  I know that you are doing well without PPIs and are opposed to their use.  I understand that.  However that route does not work/is not chosen by many. 
 
I think it's great that you represent an alternative view on the forum.  Thanks for your input! turn
Best wishes,
Denise
GERD/Heartburn Moderator
Nissen Fundoplication 2/09
Allergy/Asthma

"Whatever you fight, you strengthen, and what you resist, persists.”

“Worry pretends to be necessary but serves no useful purpose”

“Accept - then act. Whatever the present moment contains, accept it as if you had chosen it. Always work with it, not against it.”
Eckhart Tolle

sunbeam48
Veteran Member


Date Joined Jun 2011
Total Posts : 795
   Posted 2/9/2013 4:06 PM (GMT -6)   
Denise, I am sorry I have given you the impression that I am opposed to surgery. I want to do all I can to avoid it, but I see here how it has dramatically improved life for so many people.

Johnah
Regular Member


Date Joined Nov 2012
Total Posts : 34
   Posted 2/11/2013 10:50 AM (GMT -6)   
This article based on a small study suggests hyper acid secretion may last from 8-26 weeks after
stopping PPI's. It is driven by the increase in the cells while taking PPI that produce the acid in the stomach. Natures way of overcoming the impact of taking the PPI's which reduce the acid production.

I guess Gastricaman if you found it stopped after 5 days that is really good. The previous time I was on PPI's for about 3 months I transitioned back to an H2 with no issues at all. I have been taking H2's for 15 years. I am currently trying to taper off PPI's and reduce my dose from 2X20mg of Losec a day to 1 a day for a month along with 1 Zantac and then will go to 2 Zantac a day and quit the PPI. May have both the reflux and hyper secretion to deal with so we shall see how it goes. I think everyone is different when trying to get off PPI's from posts I have read.

Here is that article:

onlinelibrary.wiley.com/doi/10.1111/j.1365-2036.2004.02271.x/full
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