title: Clinical and pathophysiological consequences of on-demand treatment with PPI in endoscopy-negative reflux disease. Is rebound hypersecretion of acid a problem?
abstract: OBJECTIVE
  Rebound acid hypersecretion after withdrawal of proton pump inhibitor (PPI) may lead to symptom aggravation and difficulties in withdrawing anti-reflux medication. The aim was to investigate pathophysiological and clinical consequences of on-demand treatment with PPI in patients with endoscopy-negative reflux disease.
  
  
  METHODS
  Twenty-six patients with endoscopy-negative reflux disease were investigated for rebound effects of lansoprazole 15 mg, used on-demand, maximum 4 capsules daily during a 6-month period. P-CgA and s-gastrin were measured before, at termination and 2 weeks after stopping treatment. Symptom score was performed the week before and the second week after treatment, 24-h pH-metry after both periods.
  
  
  RESULTS
  Median daily consumption of lansoprazole was 15.1 mg (95% CI: 10.5; 18.8). S-gastrin before treatment was 31.2 pmol/l, 54.8 at the end (p < 0.01), 31.7 two weeks after withdrawal. P-CgA was 16.7 u/l before treatment, 37.5 at the end (p < 0.01), 17.7 two weeks after withdrawal (p = 0.35). A positive correlation was found between total consumption of lansoprazole and CgA increase during treatment (r = 0.44 p = 0.03). There was a reduction in symptom score during the treatment period from 30 (24-38) before, to 20 (15-36) the second week after treatment, p = 0.06. 32% had increase in symptoms.
  
  
  CONCLUSIONS
  Rebound acid hypersecretion is probably an infrequent problem in on-demand treatment with PPI in patients with endoscopy-negative reflux disease. A significant increase in p-CgA and s-gastrin was found after 6 months treatment. Fourteen days after withdrawal, CgA and gastrin returned to pretreatment levels. Overall, no aggravation of symptoms was found, but 1/3 experienced increased symptoms.
authors.affiliation: Rasta Medical Centre, Lørenskog, Norway. paul.juul-hansen@broadpark.no
authors.forename: Paul
authors.initials: P
authors.lastname: Juul-Hansen
authors.forename: Andreas
authors.initials: A
authors.lastname: Rydning
mesh_terms: D053799:2-Pyridinylmethylsulfinylbenzimidazoles / Q000008:administration & dosage / Q000009:adverse effects*; D000328:Adult; D000368:Aged; D000897:Anti-Ulcer Agents / Q000008:administration & dosage / Q000009:adverse effects*; D002864:Chromogranins / Q000187:drug effects / Q000378:metabolism; D004941:Esophagitis / Q000188:drug therapy / Q000473:pathology; D005260:Female; D005744:Gastric Acid / Q000378:metabolism*; D005755:Gastrins / Q000187:drug effects / Q000378:metabolism; D006356:Heartburn / Q000188:drug therapy* / Q000473:pathology; D006801:Humans; D064747:Lansoprazole; D057045:Laryngopharyngeal Reflux / Q000188:drug therapy* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D054328:Proton Pump Inhibitors / Q000008:administration & dosage / Q000009:adverse effects*; D012636:Secretory Rate / Q000187:drug effects
chemical_list: D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D000897:Anti-Ulcer Agents; D002864:Chromogranins; D005755:Gastrins; D054328:Proton Pump Inhibitors; D064747:Lansoprazole