[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^® 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.