To assess the effectiveness of immediate discontinuation versus gradual tapering of proton pump inhibitors (PPIs) in patients with gastroesophageal reflux disease (GERD) receiving long-term therapy.
Approach:
Study Design: Multicenter randomized controlled trial comparing immediate discontinuation with gradual tapering of PPIs.
Patient Population: Clinically stable patients with GERD on long-term PPI therapy.
Key Findings:
Success rates for discontinuation were similar between immediate discontinuation and gradual tapering at 24 and 48 weeks.
Approximately 75% of patients successfully discontinued PPI use.
Transient symptom exacerbations post-discontinuation did not hinder long-term success.
Earlier studies showed no significant advantage of tapering over abrupt discontinuation.
Interpretation:
The findings indicate that tapering PPIs may not be necessary for successful discontinuation.
Limitations:
Extrapolation from dyspepsia to GERD requires caution due to differences in patient populations.
Long-term effects of newer acid-suppressive agents like potassium-competitive acid blockers (P-CABs) are still being evaluated.
Conclusion:
Successful deprescribing of PPIs may depend on various factors, including patient-centered strategies.
