Therapy with proton pump inhibitors - when to continue, when to stop?

PPIs should work against gastrointestinal complaints, but some patients need them permanently. Researchers have set therapy guidelines for this.

Use of proton inhibitors

When should PPIs be used?

Proton pump inhibitors such as omeprazole, pantoprazole or esomeprazole are often found on the medication list of patients with heartburn or reflux disease. Not infrequently, the therapy is continued in the long term, although there is no comprehensible reason for the medication. In some cases it is a leftover from a hospital stay or the stomach protection was started some time ago and simply never ended. Whether it makes sense to continue prescribing the medication against acid reflux should be critically questioned on a regular basis. This is because medication not only causes unnecessary health care costs, but can also increase the risk of side effects (e.g. risk of pneumonia in case of overdose). In addition, there is the risk of polypharmacy, which has a stressful effect on patients.

When should proton pump inhibitors be discontinued?

Which patients benefit from stopping the medication? When should PPI use be continued? The study "Clinical Practice Update on De-Prescribing of Proton Pump Inhibitors" by Targownik and colleagues on so-called deprescribing could be helpful for this decision in everyday practice. The team has created a plan for weaning off. This can be groundbreaking. The following advice is given:

Conclusion for medical practice:

Deprescribing proton pump inhibitors is not straightforward. Even though many factors have to be taken into account, the necessity of the treatment should be reconsidered regularly. This will save patients from a possibly unnecessary therapy that may also be accompanied by side effects. The tips mentioned can be helpful here and facilitate the daily routine of a GP.

Targownik LE, Fisher DA, Saini SD. AGA Clinical Practice Update on De-Prescribing of Proton Pump Inhibitors: Expert Review. Gastroenterology. 2022 Apr;162(4):1334-1342. doi: 10.1053/j.gastro.2021.12.247. Epub 2022 Feb 17. PMID: 35183361.