Clinical Report: Reevaluating the Deprescribing of Proton Pump Inhibitors

Background

Proton pump inhibitors (PPIs) are commonly prescribed for acid-related gastrointestinal disorders, but their long-term use raises concerns about potential adverse effects. Observational studies have linked chronic PPI therapy to increased risks of enteric infections, fractures, and pneumonia. This has led to a clinical focus on optimizing deprescribing strategies to minimize unnecessary exposure.

Data Highlights

Key Findings

• Approximately 75% of patients successfully discontinued PPI use after both immediate discontinuation and gradual tapering strategies.
• Transient symptom exacerbations after discontinuation should not be interpreted as treatment failure.
• Patients with GERD were less likely to discontinue therapy compared to those without GERD.
• Structured patient education and supportive strategies are essential for successful deprescribing.
• Rebound acid hypersecretion (RAHS) is a predictable response after PPI withdrawal, necessitating appropriate patient counseling.

Clinical Implications

Understanding RAHS can aid in counseling patients about potential transient symptoms during the deprescribing process.

Conclusion

The findings indicate that both immediate and gradual approaches to deprescribing PPIs can be effective.

Related Resources & Content

1. Hojo et al., Multicenter Trial, Year -- Reevaluating the Deprescribing of Proton Pump Inhibitors
2. American Gastroenterological Association, Clinical Guidance, Year -- De-prescribing proton pump inhibitors (PPIs)
3. JAMA Internal Medicine, Year -- Deprescribing Intervention and Proton Pump Inhibitor Reduction in Primary Care
4. Frontiers in Psychiatry — Toward clarifying ASAM’s inpatient and residential benzodiazepine tapering recommendations
5. conexiant — Deprescribing Seen in T2D Care
6. Drugs - Real World Outcomes — Examination of Long-Term and High-Dose Proton Pump Inhibitor Usage: A Cross-Sectional Analysis in Six Aged Care Facilities in South Australia
7. The New Gastroenterologist — Managing GERD: Comparing Lifestyle Changes and Pharmacological Treatments
8. Toward clarifying ASAM’s inpatient and residential benzodiazepine tapering recommendations
9. Deprescribing Seen in T2D Care
10. Examination of Long-Term and High-Dose Proton Pump Inhibitor Usage
11. De-prescribing proton pump inhibitors (PPIs) - American Gastroenterological Association
12. Deprescribing Intervention and Proton Pump Inhibitor Reduction in Primary Care
13. Proton-Pump Inhibitors and Cardiovascular Adverse Events: A Meta-Analysis of Randomized Controlled Trials - PubMed