In a randomized trial performed in 2009, some asymptomatic volunteers have developed dyspeptic symptoms after being treated for 8 weeks with esomeprazole. Now, some Swedish researchers have examined the rebound phenomenon after the interruption of a therapy based on protonic pump inhibitors. 48 healthy and asymptomatic volunteers have been randomized to receive 40 mg of pantoprazole or placebo daily for 4 weeks; then, they have been followed for 6 further weeks. A week after the end of the treatment, subjects treated with the PPI presented dyspeptic symptoms more frequently than subjects treated with placebo (44% vs. 9%) and the average score on an evaluation scale for dyspepsia was significantly higher with pantoprazole (5.7 vs. 0.7). The differences between the two groups have gradually decreased during the second week and they have disappeared during the third week after assumption.
Other trials have documented the onset of dyspepsia after the interruption of a therapy based on PPIs, probably because of some gastrin-mediated phenomena, with rebound hyperacidity. The conclusion is easy: protonic pump inhibitors are very powerful drugs and they must be taken only if there is a real need, warning patients that at their interruption there can be short-duration dyspeptic symptoms.
