Análisis crítico de un artículo: La suspensión de inhibidores de la bomba de protones induciría síntomas de reflujo

Roberto Candia B
2012 Revista médica de Chile (Impresa)  
Conclusión de los revisores La suspensión de una terapia prolongada con inhibidores de la bomba de protones podría inducir pirosis y sensación de regurgitación en personas previamente asintomáticas. Pregunta clínica ¿La suspensión de una terapia crónica con in-Background & Aims: Rebound acid hypersecretion (RAHS) has been demonstrated after 8 weeks of treatment with a proton-pump inhibitor (PPI). If RAHS induces acid-related symptoms, this might lead to PPI dependency and thus have important
more » ... s have important implications. Methods: A randomized, double-blind, placebo-controlled trial with 120 healthy volunteers was conducted. Participants were randomized to 12 weeks of placebo or 8 weeks of esomeprazole 40 mg/d followed by 4 weeks with placebo. The Gastrointestinal Symptom Rating Scale (GSRS) was filled out weekly. A score of >2 on 1 of the questions regarding heartburn, acid regurgitation, or dyspepsia was defined as a clinically relevant acid-related symptom. Results: There were no significant differences between groups in GSRS scores at baseline. GSRS scores for acid-related symptoms were significantly higher in the PPI group at week 10 (1.4 ± 1.4 vs 1.2 ± 0.9; P = .023), week 11 (1.4 ± 1.4 vs 1.2 ± 0.9; P = .009), and week 12 (1.3 ± 1.2 vs 1.0 ± 0.3; P = .001). Forty-four percent (26/59) of those randomized to PPI reported ≥1 relevant, acid-related symptom in weeks 9-12 compared with 15% (9/59; P < .001) in the placebo group. The proportion reporting dyspepsia, heartburn, or acid regurgitation in the PPI group was 13 of 59 (22%) at week 10, 13 of 59 (22%) at week 11, and 12 of 58 (21%) at week 12. Corresponding figures in the placebo group were 7% at week 10 (P = .034), 5% at week 11 (P = .013), and 2% at week 12 (P = .001). Conclusions: PPI therapy for 8 weeks induces acid-related symptoms in healthy volunteers after withdrawal. This study indicates unrecognized aspects of PPI withdrawal and supports the hypothesis that RAHS has clinical implications. hibidores de bomba de protones induce síntomas asociados a reflujo gastroesofágico? Introducción El uso de inhibidores de la bomba de protones (IBP) es frecuente y en constante incremento. Datos epidemiológicos muestran que aproximadamente el 5% de la población recibe o ha recibido tratamiento a largo plazo con estas drogas 1 , lo que medicina basada en evidencia Rev med chile 2012; 140: 1073-1077 análisis crítico de un artículo: suspensión de ibP induciría síntomas de reflujo -R. candia
doi:10.4067/s0034-98872012000800017 fatcat:uor2vl4frzdxjeaucxohqyjvvy