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• W1821762679 abstract "Sirs, We read the paper ‘Systematic review: rebound acid hypersecretion after therapy with proton pump inhibitors’ by Hunfeld et al.1 with great interest. The authors based their review on eight studies where proton pump inhibitors (PPIs) were given at accepted clinical doses from 1 to 90 days and described no rebound acid hypersecretion (RAHS) in five studies where the patients/subjects were treated from 1 to 25 days and RAHS in three studies where the treatment duration was from 56 to 90 days. From these data, they concluded that there is no strong evidence for a clinically relevant increased acid production after withdrawal of PPI therapy.1 The occurence of RAHS after administration of PPI was first demonstrated in the rat after 3 months of omeprazole administration.2 Later, the same phenomenon was found in humans having used PPI for 90 days3 and after 56 days.4, 5 As regards possible mechanisms that could explain RAHS after cessation of proton pump inhibition, there is evidence that an increase in the enterochromaffin-like (ECL) cell population caused by long-term hypergastrinemia is of importance.3, 6 In the rat, we have shown that the gastrin-stimulated histamine release is dependent of the ECL cell mass,7 and it is well known that hypergastrinemia secondary to gastric hypoacidity is a natural consequence of PPI treatment, resulting in ECL cell hyperplasia.8 Two years ago, we published, in Alimentary Pharmacolocy and Therapeutics, a study that showed an increase in pentagastrin-stimulated acid secretion 4 and 8 weeks after cessation of long-term PPI-use compared with 16 and 26 weeks.6 There was a reduction in histidine decarboxylase-positive cells (ECL cells) in biopsies from the oxyntic mucosa 26 weeks after cessation compared with during PPI treatment.6 As it takes time to develop significant ECL cell hyperplasia, it is not possible to evaluate PPI-induced RAHS after one single dose, nor after 25 days use, although the studies had a randomized design. According to Hunfeld et al., the studies where PPI was administered for 1–25 days provide evidence grade A2 or B that RAHS does not occur after PPI use, whereas we would claim that these five studies merely show that PPI must be used more than 1–25 days to induce RAHS. This issue is mentioned in the discussion part of the review, but it does not influence the authors' conclusions. Moreover, we think that conclusions about the existence of RAHS should not be based on the studies that because of the study design could not possibly demonstrate RAHS. In conclusion, both physiological and statistical knowledge is needed when reviewing RASH, and at present it is meaningless to apply a meta-analysis on this biological phenomenon." @default.
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• W1821762679 date "2007-01-26" @default.
• W1821762679 modified "2023-09-24" @default.
• W1821762679 title "Rebound acid hypersecretion" @default.
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• W1821762679 doi "https://doi.org/10.1111/j.1365-2036.2007.03263.x" @default.
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