Does anyone have resources for getting patients off PPI’s? I’ve been having a lot of patients do Burp tests at home to help differentiate hypochloria vs hyperchloria. But I’m not sure how PPI’s interfere with that test, if they do? Do they need to be OFF PPI’s for a burp test to be accurate? And, if so, how in the world do I get these patients off that feel like they can’t miss a dose for fear of escalated sx?
Thanks wy307. Great ask about how to wean patients off PPIs. I’m sure those who know will weigh in.
Just on the question of whether PPI’s interfere with the tests, Perplexity seems to think they do:
For the “burp test” (baking soda test) to assess stomach acid, patients should ideally be off proton pump inhibitors (PPIs) for the test to be accurate. PPIs are very effective at suppressing stomach acid production—when taken, they can cause low stomach acid (hypochlorhydria)34. Since the burp test relies on a chemical reaction between stomach acid and baking soda to produce a burp, PPIs can artificially lower acid levels and skew the results, potentially leading to a false impression of hypochlorhydria even if the underlying acid production is normal when not on medication3.
Additionally, experts caution that the baking soda burp test itself is not a scientifically validated or reliable measure of stomach acid levels, regardless of PPI use5. There is no standardized protocol or proven accuracy for this test, and outcomes can vary widely for reasons unrelated to true stomach acid status5.
Summary:
To maximize the accuracy of the burp test, patients should not be taking PPIs, as these drugs suppress stomach acid and can interfere with the test results. However, the test itself is not considered a reliable clinical tool for diagnosing low stomach acid35. For accurate assessment, consult a healthcare provider for validated diagnostic methods.
Citations:
- https://pmc.ncbi.nlm.nih.gov/articles/PMC4624503/
- https://www.sciencedirect.com/science/article/abs/pii/S1542356512007963
- https://my.clevelandclinic.org/health/diseases/23392-hypochlorhydria
- https://refluxuk.com/education-hub/your-questions-answered-about-ppi-treatment-for-reflux
- https://www.wellandgood.com/food/baking-soda-burp-test
- https://www.healthline.com/health/gerd/gerd-not-responding-to-ppi
Based on the fact that most people taking PPIs do, actually have issues (e.g., incompetent lower esophageal sphincter, hiatal hernia) not directly related to low or high levels of stomach acid which contribute to, or even account for, their symptoms, I think the best approach is to encourage the patient to try, just for a week or so, discontinuing PPIs. Concurrent with the discontinuation, she should take a pre-meal supplement of betaine HCl, pepsin and Gentian bitters, followed by only small to medium-sized meals, taking little or no fluids at mealtime. She should drink fluids primarily between meals. If heartburn or reflux symptoms recur, then the enzyme/gentian/HCl supplementation has failed to normalize her stomach function, and perhaps she must resume taking PPIs. If symptoms do NOT recur, hallelujah! she can keep up with the enzyme supplementation and enjoy improved digestion.