Proton Pump Inhibitors: Rational Use and Use-Reduction - The Windsor Workshop

Area of Science:

• Gastroenterology
• Primary Care Medicine
• Pharmacology

Background:

• Proton pump inhibitor (PPI) overutilization persists despite deprescribing efforts.
• Meaningful reductions in PPI use remain a significant challenge in clinical practice.

Purpose of the Study:

• To define rational prescribing of PPIs.
• To identify appropriate candidates and timing for PPI use-reduction.
• To outline effective strategies for PPI deprescribing.

Main Methods:

• A comprehensive literature review was conducted.
• International primary care physicians and gastroenterologists collaborated.
• Key aspects of PPI use and reduction were analyzed.

Main Results:

• Rational PPI prescribing involves patient education on alternatives (diet, lifestyle, weight loss) before initiation.
• PPIs initiated at hospital discharge require re-evaluation for continued need.
• Long-term PPI therapy necessitates annual review.

Conclusions:

• PPI use-reduction should be based on lack of rational indication, not solely on adverse event concerns.
• Successful PPI deprescribing involves strategies like on-demand use or dose tapering with rescue therapy.
• Abrupt cessation of PPIs is less effective than gradual reduction.