Could heartburn drugs cause "rebound" symptoms?

Jul 7, 2009 12:14 PM

My husband may not always remember to take his multivitamin, but he never forgets his omeprazole. This is a type of medication called a proton pump inhibitor (PPI), and he takes it daily to keep his heartburn from flaring up. But could his dedication to this medicine actually be rooted in a drug dependency? A new study suggests this may be the case for some PPI users, showing that these drugs may cause heartburn and other "rebound" symptoms when people stop taking them.

The study, which involved 120 healthy volunteers, found that those who took a PPI called esomeprazole for eight weeks were more likely to develop heartburn, indigestion, and similar symptoms in the weeks after they stopped taking the drug. Overall, 44 percent of people who took the PPI reported at least one acid-related symptom within four weeks of stopping, compared with 15 percent of volunteers who took an inactive treatment (a placebo). The symptoms caused mild-to-moderate discomfort, and most people got them within two weeks.

If PPIs cause rebound symptoms once stopped, this could lead to people becoming dependent on them, say the researchers. To put it another way, if people get heartburn or related symptoms when they stop taking a PPI, they may think they still need the drug and continue the treatment unnecessarily.

None of the participants had frequent heartburn or related problems at the start of the study. This makes it more likely that the increase in symptoms during the study was caused by the treatment, rather than an existing condition. But it also means researchers can't be sure they'd get similar results with people taking these drugs to treat acid-related symptoms. However, studies do show that increasing numbers of people are continuing to take PPIs long term without a clear medical reason (such as severe, chronic heartburn). Rebound symptoms could be one explanation.

What you need to know. Many people do indeed need to take PPIs long term to treat their chronic heartburn. (My husband, I found out, falls under this category.) Such problematic heartburn is often caused by a condition called gastro-esophageal reflux disease (GERD for short). PPIs are designed to ease symptoms and help heal any soreness or inflammation in the esophagus.

However, people with less severe GERD are sometimes advised to take PPIs for just a short time, until their symptoms are under control and their esophagus has had a chance to heal. If you fall into this group and get heartburn or other acid-related symptoms when you stop treatment, this study suggests you might be getting rebound symptoms. But more research needs to confirm this. Studies also need to explore how long any rebound symptoms might last and the best ways to cope with them. In this study people who developed heartburn took antacids to relieve their discomfort. Gradually lowering your PPI dose might also help. It's a good idea to talk to your doctor about how long you should use a PPI and how best to stop. You might wish to mention this study as part of your discussion.

Although PPIs are considered safe treatments with few, if any, side effects, less is known about their long-term safety. Some studies suggest, for example, that prolonged use might increase the risk of broken bones due to osteoporosis.

So, as with any drug, PPIs should be used only as long as medically necessary. And if your heartburn isn't severe, you might also try nondrug measures to ease your symptoms, such as cutting down on spicy and fatty foods, quitting smoking, and curbing your alcohol and caffeine intake.

—Sophie Ramsey, patient editor, BMJ Group

ConsumerReportsHealth.org has partnered with The BMJ Group to monitor the latest medical research and assess the evidence to help you decide which news you should use.

For more on PPIs and how to save on your prescriptions, see our free Best Buy Drugs report, and for a comparison of treatments for heartburn and GERD, including information on H2 blockers and changes to your diet and lifestyle, see our Treatment Ratings (subscribers only).

Image: Rennett Stowe