Rebound acid hypersecretion after proton pump inhibitor discontinuation
Transient upper gastrointestinal symptoms due to rebound acid hypersecretion can occur after discontinuation of long-term proton pump inhibitor (PPI) therapy. [1]
Evidence Supporting Rebound Acid Hypersecretion
AGA best practice advice for PPI de-prescribing states that patients who discontinue long-term PPI therapy should be advised of potential transient upper gastrointestinal symptoms due to rebound acid hypersecretion. [1]
Clinical Context for GERD Patients
PPI discontinuation is generally not recommended for patients with complicated gastroesophageal reflux disease, including a history of severe erosive esophagitis, esophageal ulcer, or peptic stricture. [1] PPI discontinuation is generally not recommended for patients with Barrett’s esophagus, eosinophilic esophagitis, or idiopathic pulmonary fibrosis. [1]
Discontinuation Approach
When de-prescribing PPIs, either dose tapering or abrupt discontinuation can be considered. [1]
Treatment Initiation Thresholds and Indications for Continuing Therapy
Ongoing PPI indication should be reviewed and documented for all patients taking a PPI. [1] Patients without a definitive indication for chronic PPI should be considered for a trial of de-prescribing. [1]
Common Pitfalls to Avoid
De-prescribing decisions should be based on the absence of an indication for PPI use rather than concern about PPI-associated adverse events. [1] PPI-associated adverse events or risk factors for PPI-associated adverse events are not independent reasons for PPI withdrawal when an indication exists. [1]
Targets and Goals of Therapy
The goal of PPI de-prescribing is discontinuation of PPI therapy when no clear ongoing indication exists. [1]
Practical Clinical Answer to the Question
A patient with GERD who has taken pantoprazole daily for several weeks can develop transient upper gastrointestinal symptoms after discontinuation due to rebound acid hypersecretion. [1]