New recommendations on deprescribing PPIs

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The guidelines have been endorsed by the Canadian Association of Gastroenterology and the College of Family Physicians of Canada.

Concern about overuse of proton pump inhibitors (PPIs) has been growing, with studies providing evidence of a lack of ongoing indication for between 40 per cent and 55 per cent of primary care patients in the United States and the United Kingdom alone.

Deprescribing PPIs however, can be difficult and new guidelines published in Canadian Family Physician aim to assist with decisions about when and how to reduce the dose of or stop PPIs.

The guidelines recommend that the daily dose of PPIs should be decreased or stopped and changed to on-demand use for adults with upper GI symptoms who have completed a minimum four-week course of PPI treatment resulting in resolution of upper gastrointestinal (GI) symptoms. Alternatively, a histamine-2 receptor antagonist (H2RA) may be considered as an alternative to PPIs.

For those with mild to moderate GERD or upper GI symptoms who have no ongoing symptoms, the guidelines state that lowering the dose of a PPI does not lead to significantly greater relapse compared with continuing treatment at a standard dose. Both on-demand therapy and stepping down to H2RA therapy increase the risk of symptom relapse more so than lowering the dose does.

A decision-support algorithm was developed in conjunction with the guideline.

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