GERD, medicines, and Rebound Effect

GERD, or gastro-esophageal reflux disease, is a common condition in which acid stomach contents go "upstream" (reflux) from the stomach into the esophagus. The symptoms of upset stomach and burning up through you chest were probably why it used to be called "heartburn".

Medicines such as Zantac, Tagamet, Pepcid and Axid help by causing your stomach to produce less acid. Newer ones such as Prilosec, Nexium, Prevacid, Aciphex and Protonix do so even more powerfully.

Doctors are realizing within the last 6-12 months that these medicines can cause what we call tachyphylaxis, or rebound effect.

In other words if you have taken these medicines for over 3-4 weeks, your condition may be adequately treated. However, when you stop taking the pills your stomach starts to re-produce normal acids. In fact, for the first week or two it may temporarily over-produce them before coming back down to normal.

When "heartburn" symptoms returned after you stopped the pills, we used to think this meant you just had to stay on the pills for life. Now, we are concerned that for many patients this might simply be a side-effect of long-time use of the drug.

If you have been on such a medication for over 3-4 weeks and the "heartburn" comes right back within 1-3 days of stopping the medication, use Tums or Rolaids freely for a week or two if needed. These are acid buffering agents, and do not cause the same sort of rebound effect. However, they can keep your "heartburn" symptoms under control for the week or two it may take for this to subside.

Remember also that tobacco products, alcoholic beverages and anti-inflammatory pain relievers can cause or contribute to GERD. Tylenol is not such a medication, and is safe to take.

Note that this does NOT apply to patients with other conditions where life-long treatment with powerful acid reducers is entirely appropriate such as hiatal hernia, Barrett's esophagitis or GERD that does not tolerate cessation of the medications.

Also, you should seek urgent medical attention for symptoms that could represent bleeding or cancer such as obstruction to swallowing, feeling full all the time, loss of weight or appetite, rectal bleeding or black sticky bowel movements.