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Strategies for Effective Discontinuation of Proton Pump Inhibitors

  • Esophagus (J Clarke and N Ahuja, Section Editors)
  • Published:
Current Gastroenterology Reports Aims and scope Submit manuscript

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.

Summary

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.

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Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Authors and Affiliations

  1. Division of Digestive and Liver Diseases, Columbia University Medical Center, 161 Fort Washington Ave Suite 862, New York, NY, 10032, USA

    Judith Kim, John W. Blackett & Daniela Jodorkovsky

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  1. Judith Kim
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  2. John W. Blackett
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  3. Daniela Jodorkovsky
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Correspondence to Daniela Jodorkovsky.

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The authors declare that they have no conflict of interest.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Esophagus

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Kim, J., Blackett, J.W. & Jodorkovsky, D. Strategies for Effective Discontinuation of Proton Pump Inhibitors. Curr Gastroenterol Rep 20, 27 (2018). https://doi.org/10.1007/s11894-018-0632-y

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  • DOI: https://doi.org/10.1007/s11894-018-0632-y

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