Systematic reviewindependent cross-checkabstract only checked★ key study I-PPI-06 in-depth review
Rebound symptoms after stopping PPIs – review
Systematic review: symptoms of rebound acid hypersecretion following proton pump inhibitor treatment.
Overview
Lødrup AB et al.. Scand J Gastroenterol 2013 · PMID 23311977 · DOI 10.3109/00365521.2012.746395
Volunteers often get mild symptoms for up to 4 weeks; patients' studies show no clear rebound.
Does the study support the specific claim? Partly · Methodological quality: moderate
Plain-language summary
Study explained simply
- What did the researchers want to find out?
RAHS symptoms.
- How was the study done?
Systematic review.
- How many people, animals or samples were studied?
5 studies.
- What was actually found?
Mild transient symptoms in volunteers.
- How large was the observed effect?
44%.
- What do the results mean in everyday life?
Temporary symptoms.
- What are the study's limitations?
Few studies.
- What does it say about Elawady's specific claim?
Supports rebound, limits 'addiction'.
- Do the results apply to Germany and Europe?
Applicable.
- What can explicitly not be concluded from this study?
Effect in patients.
Scientific in-depth review
1. Full reference
- Authors
- Lødrup AB et al.
- Journal
- Scand J Gastroenterol
- Year
- 2013
- Identifier
- PMID 23311977 DOI 10.3109/00365521.2012.746395
- Verification
- verified – PubMed efetch 2026-10-25
- Retracted
- no
- Corrections
- none
- Extent checked
- abstract only
- Conflicts of interest and funding
not stated in abstract
2. Research question
Clinically relevant symptoms caused by acid rebound after PPI treatment
3. Study design and population
- Study design
- Systematic review – Systematic review
- Population
Volunteers and reflux patients
- Country
Multinational
- Period
PubMed search
- Sample size
5 studies
- Inclusion and exclusion criteria
Studies on RAHS symptoms
4. Methods and endpoints
- Exposure / intervention
PPI withdrawal
- Endpoints
Acid-related symptoms
- Statistical methods
Narrative synthesis
5. Actual results
- Results
Two studies in asymptomatic volunteers: 44% acid-related symptoms up to 4 weeks after withdrawal, mostly mild to moderate; three studies in reflux patients: no signs of symptomatic rebound (methodological weaknesses).
- Absolute risks
not applicable
- Authors' conclusion
RAHS induces reflux-like symptoms in volunteers; significance in patients unclear.
6. Strengths
- Focused question
7. Weaknesses
- Only PubMed; 5 studies
- Authors include Reimer (A-PPI-14) – not independent
8. Risk of bias
- Orienting tool
- ROBIS
- Type of assessment
- simplified assessment (abstract only)
- Full formal assessment
- no
- Overall risk of bias
- some concerns
- Rationale
Limited search; overlapping authors.
9. Assessment of the statistical interpretation
10. Relevance to the specific claim
C-PPI-06, -07.
11. Independent contrary findings
12. Transferability to Germany and Europe
High.
13. Overall methodological judgement
Confirms transient rebound in volunteers; uncertain in patients.
| Multidimensional assessment | |
|---|---|
| Authenticity of the source | verified |
| Methodological quality | moderate |
| Risk of bias | some concerns |
| Precision of results | not applicable |
| Directness | direct |
| Reproducibility | partly replicated |
| Consistency with the overall evidence | mixed |
| Regional transferability | high |
| Adequacy of the interpretation (by the archive) | not applicable |
14. Open questions
Rebound in patients?
15. Linked fact checks
- After stopping a PPI, rebound acid hypersecretion can cause new heartburn and reflux symptoms, even in people who had none before. – Studies supporting the claim
- PPIs create dependency: the drug 'manufactures the disease it claims to treat', so that a short course for a passing complaint turns into chronic dependence and one 'cannot stop'. – Studies contradicting or limiting the claim