Deprescribing proton pump inhibitors

Abstract

BackgroundProton pump inhibitors (PPIs) are indicated for disorders including peptic ulcer disease and gastro-oesophageal reflux disease; however, they are often used for longer and at higher doses than recommended, or for indications that are not supported by evidence. ObjectiveThe aim of this article is to outline evidence-based approaches to deprescribing PPIs. DiscussionPPIs are generally well tolerated; however, use beyond eight weeks is rarely indicated and increases the risk of adverse events. PPI deprescribing should be considered when there is no indication for long-term therapy. Evidence supports a patient-centred approach to PPI deprescribing involving stepping down the dose before ceasing or switching to pro re nata (PRN; 'as needed') use. Abrupt PPI discontinuation may result in shortterm rebound acid hypersecretion that can mimic symptom return. This can be minimised with gradual dose tapering prior to discontinuation and managed with PRN treatment. Prescribers should discuss the rationale for PPI deprescribing and involve patients in developing the deprescribing plan.

Diets including Animal Food Are Associated with Gastroesophageal Reflux Disease

“…In line with the trend of proton pump inhibitor deprescription in GERD management [24], it is important to identify and reduce any modifiable risk factor of the disease. Several lifestyle factors have been associated with GERD [10]; however, beneficial effects have only been documented for weight loss and tobacco smoking cessation in obese patients and smokers, respectively, and for avoiding late evening meals and elevating the head of the bed for nocturnal GERD [8,21].…”

Strategies to guide the successful implementation of deprescribing in community practice: Lessons learned from the front line

“…7,8,[12][13][14][15] The province of Newfoundland and Labrador (NL) has one of the highest prevalences of potentially inappropriate medications within Canada. 2 Proton pump inhibitors (PPIs), which are often used long term unnecessarily, 16 are used by 27% of the province, and sedatives, which can increase the risk of medication-related harm, are used long term by 22% of the population. 3 The prevalence of these medications continued to increase after 2011 3 ; therefore, in response to this pressing problem, in 2019, the NL government sought to scale up and spread evidence-based interventions to reduce the longterm use of sedatives and PPIs.…”

Nuevas herramientas para la revisión de la medicación: PRM en pacientes en tratamiento con inhibidores de la bomba de protones

“…Pese a que los IBP son efectivos para una gran variedad de patologías gastrointestinales y deben tomarse durante periodos de tiempo prolongados (sobre las ocho semanas), en muchas ocasiones los pacientes continúan tomándoselos durante años 12 . Existe evidencia que sugiere que del 22 al 63% de los IBP se toman durante más tiempo del necesario 13 . Siguiendo las directrices del National Institute for Health and Care Excellence (NICE) y las guías de expertos, se recomienda reevaluar el tratamiento a largo plazo con IBP y, cuando sea necesario, intentar reducir o suspender su prescripción, con el objetivo principal de disminuir su consumo y los costes innecesarios, así como los posibles efectos adversos que se deriven de su uso prolongado 12 , 13 .…”