Discontinuing Long-Term PPI Therapy: Why, With Whom, and How?

Area of Science:

• Pharmacology and Therapeutics
• Gastroenterology
• Drug Safety

Background:

• Proton pump inhibitors (PPIs) represent a cornerstone of acid-suppression therapy, with widespread long-term use in clinical practice.
• An estimated 8-10% of ambulatory adults have received a PPI prescription within the last 30 days, highlighting their prevalence.
• Growing evidence suggests potential long-term safety concerns associated with continuous PPI utilization.

Purpose of the Study:

• To critically evaluate the existing evidence linking PPI use to adverse health outcomes and assess the causality of these associations.
• To identify specific patient populations, particularly long-term users, who may be candidates for reducing PPI therapy intensity or discontinuing treatment.
• To outline practical strategies for tapering or stopping chronic PPI therapy while ensuring sustained symptom control and minimizing the risk of recurrence.

Main Methods:

• Systematic review of published literature on PPIs and adverse events.
• Analysis of epidemiological studies and clinical trial data.
• Evidence-based guideline development for PPI de-escalation.

Main Results:

• The review synthesizes data on various adverse events linked to long-term PPI use, discussing the strength of evidence for causality.
• Criteria for identifying patients suitable for PPI dose reduction or discontinuation are presented.
• Effective strategies for managing acid-related symptoms during and after PPI cessation are detailed.

Conclusions:

• Long-term PPI therapy necessitates careful risk-benefit assessment due to emerging safety concerns.
• A significant proportion of long-term PPI users may be candidates for de-escalation or discontinuation.
• Structured approaches and patient-centered strategies are crucial for successful PPI deprescribing while maintaining gastrointestinal health.