Judith Kim1, John W Blackett1, Daniela Jodorkovsky2. 1. Division of Digestive and Liver Diseases, Columbia University Medical Center, 161 Fort Washington Ave Suite 862, New York, NY, 10032, USA. 2. Division of Digestive and Liver Diseases, Columbia University Medical Center, 161 Fort Washington Ave Suite 862, New York, NY, 10032, USA. dj2470@cumc.columbia.edu.
Abstract
PURPOSE OF REVIEW: Proton pump inhibitors (PPIs) are effective for many conditions but are often overprescribed. Recent concerns about long-term risks have made patients re-evaluate their need to take PPIs chronically, though these population-based studies have methodological weaknesses. The goal of this review is to provide evidenced-based strategies for discontinuation of PPI therapy. RECENT FINDINGS: Given that some patients experience rebound symptoms when abruptly stopping continuous PPI therapy due to its effect on hypergastrinemia, strategies focus on avoiding rebound. Tapering the PPI and then initiating a "step-down" approach with the use of alternative medications may be effective. "On-demand therapy" provides patients with the option to take intermittent PPI courses, reducing overall use and cost while preserving patient satisfaction. It is important for providers to consider ambulatory pH or pH/impedance testing to rule out diagnoses that may require alternative medications like neuromodulators. A number of studies reviewed here can provide guidance in counseling patients on PPI discontinuation. It is important for the provider to obtain a baseline needs assessment for PPI therapy and to elucidate predictors of difficulty in discontinuation prior to initiating a strategy.
PURPOSE OF REVIEW: Proton pump inhibitors (PPIs) are effective for many conditions but are often overprescribed. Recent concerns about long-term risks have made patients re-evaluate their need to take PPIs chronically, though these population-based studies have methodological weaknesses. The goal of this review is to provide evidenced-based strategies for discontinuation of PPI therapy. RECENT FINDINGS: Given that some patients experience rebound symptoms when abruptly stopping continuous PPI therapy due to its effect on hypergastrinemia, strategies focus on avoiding rebound. Tapering the PPI and then initiating a "step-down" approach with the use of alternative medications may be effective. "On-demand therapy" provides patients with the option to take intermittent PPI courses, reducing overall use and cost while preserving patient satisfaction. It is important for providers to consider ambulatory pH or pH/impedance testing to rule out diagnoses that may require alternative medications like neuromodulators. A number of studies reviewed here can provide guidance in counseling patients on PPI discontinuation. It is important for the provider to obtain a baseline needs assessment for PPI therapy and to elucidate predictors of difficulty in discontinuation prior to initiating a strategy.
Authors: Luis Furuya-Kanamori; Jennifer C Stone; Justin Clark; Samantha J McKenzie; Laith Yakob; David L Paterson; Thomas V Riley; Suhail A R Doi; Archie C Clements Journal: Infect Control Hosp Epidemiol Date: 2015-02 Impact factor: 3.254
Authors: Nikos Viazis; Anastasia Keyoglou; Alexandros K Kanellopoulos; George Karamanolis; John Vlachogiannakos; Konstantinos Triantafyllou; Spiros D Ladas; Dimitrios G Karamanolis Journal: Am J Gastroenterol Date: 2011-05-31 Impact factor: 10.864
Authors: D A Leiman; B P Riff; S Morgan; D C Metz; G W Falk; B French; C A Umscheid; J D Lewis Journal: Dis Esophagus Date: 2017-05-01 Impact factor: 3.429
Authors: Serhat Bor; İsmail Hakkı Kalkan; Altay Çelebi; Dinç Dinçer; Filiz Akyüz; Peter Dettmar; Hasan Özen Journal: Turk J Gastroenterol Date: 2019-09 Impact factor: 1.852