If you throw a dart blindly on a USA map, there is good chance that people who live in the vicinity of the dart have either used or are using a Proton Pump Inhibitor (PPI) ! But as common as they are , some facts about them ain’t so well known. I already covered their second useful clinical effect before.
When PPIs like Pantoprazole (Protonix), Omeprazole (Prilosec) , etc are taken daily for more than a month , the hormone Gastrin that normally stimulates gastric acid secretion starts questioning it’s life’s purpose & runs around confused like The Weeknd in that terrible super-bowl maze show. Our body generates more gastrin to try & break the PPI-induced acid block on parietal cells – which doesn’t work, so gastrin levels keep building up slowly, hoping. Then one day when the med is stopped with all that pent-up blood gastrin running hot , imagine the tsunami of gastrin-induced stomach acid secretion that occurs once the acid block is suddenly gone ! This is what creates the “acid-rebound” effect of stopping proton pump inhibitors after a longer use. This effect tapers off in a month as gastrin levels calm down.
💡 Always warn your patients about this effect if they are prescribed PPIs for more than a month (for example in GI bleed, ulcers, etc. cases ). Otherwise patients might go back to using PPIs for treating the rebound symptoms thinking they aren’t completely healed yet. They may potentially never want get off those and then incur PPI side-effects. So advise them in advance to use chewable antacids & Histamine-2-Receptor blockers like Pepcid for expected acid-rebound management.
💡 Likewise, if you admit someone taking long term PPIs and don’t continue it while inpatient , expect their gastric parietal cells to spew out gastric acid like the the niagara falls with nausea , burning pain , heartburn etc .
P.S. : Do you know where the word ‘Protonix’ came from ?
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