Exacerbation of gastroesophageal reflux symptoms after discontinuation of proton pump inhibitors is not associated with increased esophageal acid exposure

Abstract

BackgroundDiscontinuation of long‐term proton pump inhibitors (PPIs) on patients with reflux symptoms can be challenging, as symptoms often exacerbate after stopping. The mechanism remains unknown. Our aim was to evaluate the impact of stopping long‐term PPIs on patients with heartburn, and its association with esophageal acid exposure.MethodsPatients with heartburn on long‐term PPIs underwent symptom questionnaire, high‐resolution manometry, and 24h ambulatory impedance‐pH studies, following a 7‐day PPIs discontinuation. We investigated the association between exacerbation of symptoms and findings on ambulatory reflux studies.Key ResultsWe studied 37 patients. After stopping PPIs, 27 patients (73%) had exacerbation of heartburn. Esophageal acid exposure time% (AET) in patients with exacerbation of heartburn was not significantly higher than in patients without (3.5% [1.3‐9.7] vs 2.5% [1.3‐8.7], NS). Fourteen of 27 patients with exacerbation had physiological AET (<4%) as compared with 6 of 10 patients with physiological AET (NS). All questioned symptoms (heartburn, regurgitation, epigastric discomfort/pain, bloating/belch) worsened after stopping PPIs (NS).Conclusions & InferencesExacerbation of heartburn after discontinuation of PPIs does not appear to be due to increased esophageal acid exposure.

Reduction of the Risk of Relapse of Symptoms When Using Esophagoprotector in Patients Requiring Temporary Cancellation of Antisecretory Therapy

“…На сегодняшний день антисекреторная терапия с использованием ИПП является терапией первой линии при индукции и поддержании ремиссии ГЭРБ [12,13,[24][25][26][27]. В рутинной клинической практике нередко бывают ситуации, при которых требуется временная (от одной недели до месяца) отмена ИПП для валидного проведения ряда диагностических мероприятий, что может привести к рецидиву симптоматики у значимой части пациентов [2,18,19,21,22]. Предупреждение рисков рецидива с применением современных групп препаратов является важной задачей современной гастроэнтерологии, так как от его успеха зависит качество жизни пациента -главного интегрального показателя качественной медицинской помощи [2].…”

“…Отмена ИПП может привести к рецидиву симптоматики у значимой части пациентов, что негативно скажется на их качестве жизни. В ряде исследований частота рецидива при отмене ИПП достигала 60-80% [20][21][22]. Использование антацидных препаратов для снижения риска рецидива симптоматики на время отмены ИПП малоэффективно ввиду выраженной краткосрочности их действия.…”

Clinical impact of proton pump inhibitor response and dependence

“…We have read with interest the paper by Hoshikawa et al, 1 addressing a very important issue in our clinical practice, that is, the so-called proton pump inhibitor (PPI) dependence in patients with gastro-esophageal reflux disease (GERD) symptoms. Indeed, the management of these patients is challenging since, even following a more accurate assessment with sophisticated and not widely available techniques -impedance-pH monitoring and esophageal high-resolution manometry-, the partial PPI response and the exacerbation of symptoms following discontinuation of PPI raise diagnostic uncertainties and, As the author speculates in the Discussion, the visceral hypersensitivity may play a relevant role in this matter.…”

Randomised clinical trial: the use of alginates during preinvestigation proton pump inhibitor wash-out and their impact on compliance and symptom burden

“…When asked anonymously, 15% admitted to surreptitiously taking PPIs during the abstinent period, potentially impacting test accuracy. 7 …”

“…6 This can be due to resumption of acid reflux, but in other patients the symptom exacerbation occurs even in the absence of pathological exposure. 7 Open access individuals. 8 9 Consequently, many patients may take PPIs unnecessarily.…”