Tapering

For patients who have made positive lifestyle changes and are less likely to need continued chronic acid suppression, it can still be difficult to come off PPIs. They often cause rebound hyperacidity, even if the underlying condition has resolved.¹ This occurs due to the lower stomach acidity increasing gastrin secretion, which causes the enterochromaffin cells to hypertrophy. When the PPI is suddenly discontinued, these larger cells have an increased capacity for acid secretion.² Figure 1 shows symptoms scores for dyspepsia in asymptomatic people given 40 milligrams of pantoprazole for 6 weeks versus controls. Despite being initially asymptomatic, they experienced rebound dyspepsia that lasted 10-14 days.¹

Figure 1. Symptoms of reflux in people without GERD when taking PPIs versus placebo.¹ Blue, dashed = Took PPI; Red, solid = Placebo group. Reprinted by permission from Macmillan Publishers LTD: American Journal of Gastroenterology, copyright 2010.

When counseling about discontinuing a PPI, let patients know that they will likely have symptoms of reflux for about 2 weeks after they stop the medication. Fortunately, there are strategies to help calm reflux symptoms until rebound hyperacidity resolves.

Bridge Therapy

The following therapies will not only increase success for discontinuing a PPI but also are therapeutic for gastroesophageal reflux disease (GERD).

1. Focus on nutrition. Common foods that should be avoided in those with GERD include alcohol, caffeine (coffee), chocolate, cow’s milk, animal fat, and orange juice.