Half-dose PPI and hypergastrinemia: Who should be monitored? :- Medznat
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Hypergastrinemia on half-dose PPI: Who’s at risk?

GERD GERD
GERD GERD

What's new?

Older age, high baseline serum gastrin levels, and low pepsinogen ratios are key predictors of hypergastrinemia development in patients on maintenance therapy for mild GERD.

A new study sheds light on the key factors predicting hypergastrinemia (gastrin levels exceeding the normal range) in patients undergoing maintenance therapy for mild gastroesophageal reflux disease (GERD) with a half-dose proton pump inhibitor (PPI). Researchers found that older age, high baseline serum gastrin levels, and low baseline pepsinogen ratios substantially heighten the likelihood of developing elevated gastrin levels after treatment.

The study analyzed 293 patients from a prospective, randomized trial comparing two PPI maintenance strategies—continuous vs. on-demand therapy—for mild GERD. Researchers evaluated multiple factors, including age, sex, body mass index (BMI), Helicobacter pylori (H. pylori) infection status, baseline gastrin levels, pepsinogen I/II ratios, total days of PPI use, and weight-based PPI dosage (mg/kg). Univariate analysis depicted significant correlations between post-treatment gastrin levels and older age (P < 0.001),  H. pylori infection (P = 0.012), higher baseline gastrin levels (P < 0.001), and lower pepsinogen ratios (P = 0.016).

Multivariate analysis confirmed that age, baseline gastrin levels, and baseline pepsinogen ratios were independent predictors of both final gastrin levels and the development of hypergastrinemia after PPI therapy. Interestingly, whether patients used continuous or on-demand therapy did not markedly alter these risk factors, suggesting that some individuals are inherently more prone to PPI-elicited hypergastrinemia regardless of dosing strategy.

These findings highlight the requisition for personalized PPI therapy based on individual risk factors. Those with high baseline gastrin levels or low pepsinogen ratios—especially older adults—may require closer monitoring of serum gastrin levels and possibly alternative GERD care strategies. As PPIs remain a cornerstone of GERD treatment, could routine biomarker screening help tailor therapy and reduce long-term risks? This study suggests that in the future, a one-size-fits-all approach to PPI therapy may not be the best option for everyone.

Source:

Journal of Neurogastroenterology and Motility

Article:

Predictors for the Development of Hypergastrinemia in Maintenance Treatment for Mild Gastroesophageal Reflux Disease Using a Half-dose Proton Pump Inhibitor

Authors:

Da Hyun Jung et al.

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