For individuals who have made positive lifestyle changes and may no longer need continued chronic acid suppression, it can often be difficult to come off of PPIs since this can cause rebound hyperacidity even if the underlying condition has resolved. (1) Symptoms of dyspepsia in ASYMPTOMATIC people given 40 mg of pentoprazole for 6 weeks tend to reveal rebound dyspepsia that lasts 10-14 days. (1)
Some individuals slowly taper off the PPI over 2-4 weeks (the higher the dose, the longer the taper). While the taper is being completed, they might consider some form of “bridge therapy” to reduce the symptoms of rebound hyperacidity.
- Encourage regular aerobic exercise
- Encourage a relaxation technique such as deep breathing (this enhances vagal stimulation, encouraging digestion and aids peristalsis.
- Acupuncture 1-2 times weekly. (2)
Add one or more of the following:
Deglycyrrhizinated Licorice (DGL), 2-4 380 mg tablets before meals or Sucralfate (Carafate) 1 gm before meals. Slippery Elm, 1-2 tbsp of powdered root in water or 400-500 mg capsules or 5 ml of a tincture three to four times daily.
A combination botanical product, Iberogast® (Clown’s mustard, German chamomile, angelica root, caraway, milk thistle, lemon balm, calendine, licorice root and peppermint leaf). 1 ml three times daily.(3)
If acid reflux returns, some individuals work with positive lifestyle changes, or introduce an H2-Blocker. If symptoms are still difficult to control, consideration can be given to adding the PPI back.
It is beneficial to avoid long-term acid suppression if possible since this can be associated with mal-absorption of vitamin B12 and iron,(4) increased risk of community acquired pneumonia, (5) hip (6), (7 )and spine (8), (9) fracture, and C. diff diarrhea.(10)
- Niklasson A, Lindstrom L, Simren M, Lindberg G, Bjornsson E. Dyspeptic symptom development after discontinuation of a proton pump inhibitor: A double-blind placebo-controlled trial. Am J Gastroenterol. 2010; .
- Dickman R, Schiff E, Holland A, et al. Clinical trial: Acupuncture vs. doubling the proton pump inhibitor dose in refractory heartburn. Aliment Pharmacol Ther. 2007; 26(10):1333-1344.
- Melzer J, Rosch W, Reichling J, Brignoli R, Saller R. Meta-analysis: Phytotherapy of functional dyspepsia with the herbal drug preparation STW 5 (iberogast). Aliment Pharmacol Ther. 2004; 20(11-12):1279-1287.
- Jensen RT. Consequences of long-term proton pump blockade: Insights from studies of patients with gastrinomas. Basic Clin Pharmacol Toxicol. 2006; 98(1):4-19.
- Laheij RJ, Sturkenboom MC, Hassing RJ, Dieleman J, Stricker BH, Jansen JB. Risk of community-acquired pneumonia and use of gastric acid-suppressive drugs. JAMA. 2004; 292(16):1955-1960.
- Corley DA, Kubo A, Zhao W, Quesenberry C. Proton pump inhibitors and histamine-2 receptor antagonists are associated with hip fractures among at-risk patients. Gastroenterology. 2010; 139(1):93-101.
- Gray SL, LaCroix AZ, Larson J, et al. Proton pump inhibitor use, hip fracture, and change in bone mineral density in postmenopausal women: Results from the women’s health initiative. Arch Intern Med. 2010; 170(9):765-771.
- Kwok CS, Yeong JK, Loke YK. Meta-analysis: Risk of fractures with acid-suppressing medication. Bone. 2010; .
- Insogna KL. The effect of proton pump-inhibiting drugs on mineral metabolism. Am J Gastroenterol. 2009; 104 Suppl 2:S2-4.
- Cunningham R, Dale B, Undy B, Gaunt N. Proton pump inhibitors as a risk factor for clostridium difficile diarrhoea. J Hosp Infect. 2003; 54(3):243-245.