Refractory Diarrhea After Dor Fundoplication: The Long-Term Impact of Proton Pump Inhibitor Therapy

TL;DR

A patient developed chronic diarrhea after stopping proton pump inhibitors following surgery, which was resolved by restarting the medication.

Contribution

Highlights a possible link between PPI discontinuation and gastrointestinal dysfunction resembling withdrawal effects.

Findings

Chronic diarrhea occurred after discontinuing proton pump inhibitors post hiatal hernia surgery.

Reintroducing proton pump inhibitors resolved the diarrhea within days.

The case suggests a potential withdrawal-like effect from stopping long-term PPI therapy.

Abstract

Persistent diarrhea following hiatal hernia repair is a rare but noteworthy postoperative complication. In this case, we present a 62-year-old female with a longstanding history of gastroesophageal reflux disease (GERD) responsive to proton pump inhibitors (PPIs). After undergoing robotic-assisted hiatal hernia repair with partial fundoplication, the patient discontinued PPI therapy and subsequently developed chronic diarrhea. Extensive testing, including stool cultures, returned negative, and antidiarrheal medications provided minimal relief. Interestingly, reintroduction of PPI therapy resulted in a complete resolution of symptoms within days. This case suggests a possible correlation between cessation of long-term PPI use and gastrointestinal dysfunction, with chronic diarrhea manifesting as a withdrawal-like effect. Further investigation into the role of PPI discontinuation on gut microbiota and its clinical outcomes is necessary to understand this phenomenon better.

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