Discontinuation of Proton Pump Inhibitors in Patients on Long-Term Therapy: A Double-Blind, Placebo-Controlled Trial

Aliment Pharmacol Ther. 2006 Sep 15;24(6):945-54. doi: 10.1111/j.1365-2036.2006.03084.x.

Abstract

Background: The proportion of proton pump inhibitor users on long-term therapy who can discontinue proton pump inhibitor (PPI) medication without developing symptoms is unknown.

Aim: To determine the proportion of patients on long-term PPI therapy who are able to discontinue PPIs without developing symptoms.

Methods: Patients on long-term PPIs, without a history of peptic ulcer or esophagitis underwent upper endoscopy. Patients were randomized double-blindly to taper down or continue a constant dosage of omeprazole for three weeks. Thereafter, all patients discontinued PPIs.

Results: Of the 97 patients enrolled, had used PPIs for 48 months, 78% had GERD. A total of 27% did not use PPIs during the year after discontinuation, 31% of the patients randomized to tapering discontinued PPIs and 22% of those who did not could discontinue therapy (NS). Gastro-oesophageal reflux disease (GERD) patients were more prone to continue PPIs than non-GERD patients. Only 16 (21%) of GERD patients were off PPIs vs. 48% of patients without GERD (p < 0.05). Serum gastrin was higher at baseline in GERD patients who resumed PPIs versus non-resumers (p < 0.05). GERD and serum gastrin were independent predictors of PPI requirement.

Conclusions: Discontinuation of PPI was successful in 27% of long-term PPI users. GERD patients had more difficulty discontinuing PPIs than non-GERD patients.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Double-Blind Method
  • Drug Administration Schedule
  • Dyspepsia / blood
  • Dyspepsia / drug therapy
  • Enzyme Inhibitors / administration & dosage*
  • Female
  • Gastrins / blood
  • Gastroesophageal Reflux / blood
  • Gastroesophageal Reflux / drug therapy*
  • Humans
  • Long-Term Care
  • Male
  • Middle Aged
  • Omeprazole / administration & dosage
  • Proton Pump Inhibitors*
  • Quality of Life
  • Treatment Outcome
  • Withholding Treatment

Substances

  • Enzyme Inhibitors
  • Gastrins
  • Proton Pump Inhibitors
  • Omeprazole