H2-blocker tachyphylaxis may limit LPR therapy

Acid suppression wanes rapidly with repeated dosing, supporting intermittent use and phenotype-directed evaluation of persistent symptoms.

1

Continuous H2-receptor antagonist therapy can lose acid-suppressive efficacy within days, with evidence showing loss by about day 5.
2

Dose escalation does not overcome H2-receptor antagonist tachyphylaxis, and a bedtime H2-receptor antagonist added to a PPI lost its initial benefit within 1 week.
3

Contemporary gastroenterology guidance supports H2-receptor antagonists mainly for intermittent or as-needed use, not as daily adjunctive therapy.
4

Persistent LPR symptoms may reflect nonacid reflux components or mechanisms unrelated to reflux, rather than inadequate acid suppression.
5

For persistent symptoms, investigators favored reassessing adherence and diagnosis and considering objective reflux testing over indefinite escalation of empiric therapy.

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