A narrative review on rebound acid hypersecretion due to long-term use of proton pump inhibitors

Abstract

Objectives Proton pump inhibitors (PPIs) are the most commonly used drugs to reduce hyperacidity. The usage of PPIs reduces the secretion of gastric juice; their prolonged usage results in gastric acid suppression with hypergastrinemia while their stoppage results in hypersecretion of gastric juice. This kind of paradoxical reaction is seen in the rebound effect of drugs. Dr. Samuel Hahnemann gave us the vital principles of homeopathy, the law of similitude, i.e., “similia similibus curentur” derived from the “Nature’s Law of Cure”. This also tells us that the primary action of medicine stimulates the dynamic expression of an organism (vital force), which results in the counteraction called secondary action by the organism. Material and Methods Review of literature on the effects of long-term use of PPIs and rebound hypersecretion of gastric juice due to PPIs. Results For this review article, 16 most relevant articles are selected from the search results. Thirteen systematic reviews, two randomized control trials, and one pilot study are included. Rebound acid hypersecretion (RAHS) occurs after prolonged treatment with histamine-2 blockers and PPIs, causing gastric hypoacidity and hypergastrinemia. Longer PPI durations can result in prolonged hypersecretion, with moderate hypergastrinemia and increased enterochromaffin-like (ECL) cell hyperplasia. Deprescribing PPIs is crucial to reduce RAHS and safety concerns. Long-term usage can lead to nutritional deficiencies, respiratory infections, and bone fractures. Conclusion Homeopathic remedies have shown significant results in treating symptoms caused due to gastritis, ulcers, gastroesophageal reflux disease, etc., and further research is needed to reduce RAHS caused due to the long-term use of PPIs.