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Washout

A two-week washout period is sometimes required when referring your patients for diagnostic testing to improve efficacy. However, rebound symptoms can make patient adherence challenging. If these symptoms are not managed effectively, patients may return to proton pump inhibitor (PPI) use whilst under investigations, which can limit the results collected. By initiating alternative management strategies with your washout patients during this period, you can mitigate this risk. Expand the information below to understand how you can incorporate these strategies into your patient care.

  • About the patient

    Some patients must stop PPI therapy for further investigation. These include:

    • Endoscopy
    • Helicobacter pylori testing
    • Physiology testing

  • Treatment goals

    The aim of washout is to increase the efficacy of diagnostic testing. To do so, your patients must refrain from taking PPIs during the washout period. You can initiate treatment strategies with these patients to maintain this.

  • Challenges faced

    1. Rebound acid hypersecretion

      Gastrin production increases in patients on PPI therapy. When therapy is stopped, the elevated levels of gastrin remain, causing increased experience of reflux symptoms.

    2. Patient adherence

      Due to rebound symptoms, your patients may find it difficult to adhere to the washout period requirements.

  • Consultation advice

    You can initiate management strategies for this two-week period to reduce rebound symptoms and ensure diagnostic efficacy.

    • Regular alginate therapy

      As alginates do not interrupt acid physiology, they do not affect the efficacy of diagnostic tests. Therefore, you should prescribe regular alginate therapy to your washout patients to limit their experience of rebound symptoms. Patients must take alginates after meals regularly for the entire two weeks of washout.

    • Manage patient expectations

      By knowing the likelihood of rebound symptoms and what to do to reduce them (e.g. taking regular alginate therapy), your patients will be better equipped to maintain the washout period.

    • Patient education

      A patient’s understanding of why they must undergo washout can often improve their adherence.

  • Resources

This content hub is funded by RB. The view and opinions presented here represent those of the doctors and do not reflect those of RB.

UK/G-NHS/0818/0015
Date of preparation: October 2018

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