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Am Fam Physician. 2022;106(6):702-703

Author disclosure: No relevant financial relationships.

Clinical Question

What is the most effective method for deprescribing chronic use of proton pump inhibitor (PPI) medications?

Evidence-Based Answer

Several deprescribing methods may provide limited success. Some patients may have a return of symptoms with abrupt discontinuation. (Strength of Recommendation [SOR]: B, placebo arms in randomized controlled trials [RCTs].) Changing the PPI prescription to as-needed dosing results in fewer pills being used (by about four pills per week), but with lower patient satisfaction and less symptom control. (SOR: A, meta-analysis.) Taking a PPI as needed decreases use in two-thirds of patients. (SOR: B, RCTs.) Adding a rescue histamine H2 blocker may reduce the risk of restarting a PPI by about 80%. (SOR: B, secondary outcome in small RCTs.)

Evidence Summary

Deprescribing is recommended for patients with gastroesophageal reflux disease (GERD) who are low risk and are symptom-free after four weeks of PPI therapy. A systematic review and meta-analysis identified six RCTs (n = 1,758) of adults 48 years and older with nonerosive GERD or milder grades of reflux esophagitis (Los Angeles classification system for GERD grades A and B) comparing symptom control, pill burden, and patient satisfaction in patients deprescribed PPIs.1 Researchers compared abrupt withdrawal and changing to as-needed treatment with continuing daily therapy. Researchers measured outcomes using symptom surveys. Compared with continuous PPI use, the as-needed PPI regimen had a higher risk of poorly controlled symptoms (relative risk [RR] = 1.71; 95% CI, 1.31 to 2.21) and reduced patient satisfaction (RR = 1.82; 95% CI, 1.26 to 2.65), although with a lower pill burden (mean difference = −3.79 pills per week; 95% CI, −4.73 to −2.84). One study (n = 105) examined abrupt discontinuation in an older study group (mean age = 73 years) who all had endoscopic evidence of erosive esophagitis. Symptoms returned in two-thirds of patients who abruptly stopped their PPI (67.9% vs. 22.4% for continuous use; RR = 3.02; 95% CI, 1.74 to 5.24). Trials were inconsistent in how they reported symptom control, the studies were not always blinded, and many trials had small sample sizes.

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Clinical Inquiries provides answers to questions submitted by practicing family physicians to the Family Physicians Inquiries Network (FPIN). Members of the network select questions based on their relevance to family medicine. Answers are drawn from an approved set of evidence-based resources and undergo peer review. The strength of recommendations and the level of evidence for individual studies are rated using criteria developed by the Evidence-Based Medicine Working Group (

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