Proton pump inhibitors (PPIs)

Risk of rebound acid hypersecretion (RAHS)

New Zealand. Medsafe has announced that rebound acid hypersecretion (RAHS) has been reported in patients after stopping prolonged treatment with proton pump inhibitors (PPIs).

PPIs (omeprazole, lansoprazole and pantoprazole) inhibit gastric acid secretion and have several indications such as the short-term treatment of benign duodenal and gastric ulcers and the eradication of Helicobacter pylori in combination with antibacterials.

RAHS is the recurrence of symptoms due to an increase in gastric acid secretion above pretreatment levels after stopping PPI therapy. Symptoms of RAHS may include heartburn, regurgitation or dyspepsia.

For many people, short-term PPI use (4-8 weeks) is appropriate. A step-down approach should be considered when stopping PPI therapy. Stepping down involves gradually reducing the dose over time before stopping the medicine completely. Alternative treatments such as histamine H2-receptor antagonists or antacids may be useful to manage rebound symptoms.

Reference : Prescriber Update, Vo. 40, No.2, Medsafe, June 2019 (medsafe.govt.nz/)