[Proton pump inhibitor deprescribing interventions in primary care: A systematic review]

The chronic use of proton pump inhibitors (PPIs) in primary care, often without a clearly justified clinical indication, significantly contributes to polypharmacy and is associated with a higher risk of adverse effects. In this context, the objective of this systematic review was to synthesize the most recent evidence on the effectiveness and applicability of deprescribing interventions aimed at the chronic use of PPIs in primary care. The PRISMA guidelines were followed during the review process. The literature search was conducted in the MEDLINE/PubMed, Scopus, Cochrane Library, CINAHL, and Google Scholar databases, using free and controlled vocabulary with the MeSH terms Proton Pump Inhibitors, Deprescribing, Medication Withdrawal, and Primary Health Care, combined with the Boolean operators AND and OR. The search was limited to articles published between 2021 and 2026. Eight original studies were included, primarily clinical trials, mostly conducted in European countries. The interventions evaluated included patient education strategies, healthcare professional training, the use of clinical algorithms, and clinical decision support tools. Most studies showed a significant reduction in chronic PPI use without a clinically relevant increase in acid rebound symptoms, while maintaining an adequate safety profile. The findings of this review suggest that PPI deprescribing interventions are feasible and potentially effective in primary care. In particular, low-cost, educational strategies based on shared decision-making can contribute to improving prescribing quality and reducing inappropriate PPI use in routine clinical practice.