Gastric acid rebound after a proton pump inhibitor: Narrative review of literature

Background.- Since the introduction of the first proton pump inhibitor (PPI) 20 years ago, studies have examined the presence of a rebound effect when this treatment is discontinued. These studies are heterogeneous and contradictory: the last literature review on the rebound in gastric acidity dates from 2006 and did not allow to conclude on the subject. Our objective was to carry out an up-to-date literature review on the existence and characteristics of this gastric acid rebound at the end of PPIs. Methods.- We conducted a review of the literature on the gastric acid rebound, without excluding the design of the studies. The Medline (R) databases (PubMed), ISI (Web Of Science) and Google Scholar were queried using the following equation: (inhibitor proton pump OR omeprazole OR esomeprazole OR lansoprazole OR pantoprazole OR rabeprazole) AND rebound AND Acid hypersecretion. Only studies with a measure (whatever it was) before and after treatment were analyzed. Results.- Of the 131 publications identified, 10 were selected. The design of the studies was very heterogeneous. Five studies concluded a rebound effect. Studies with a treatment duration of less than 4 weeks did not demonstrate a rebound effect. The colonization with Helicobacter pylori masked the appearance of the rebound. Conclusion.- Daily PPI exposure for more than 4 weeks is likely to trigger a rebound of acid hypersecretion about 15 days after discontinuation, and lasting from a few days to several weeks depending on the duration of the exposure. (C) 2017 Societe francaise de pharmacologie et de therapeutique. Published by Elsevier Masson SAS. All rights reserved.