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Practice Guideline
. 2017 May;63(5):354-364.

Deprescribing proton pump inhibitors: Evidence-based clinical practice guideline

Barbara Farrell  1 , Kevin Pottie  2 , Wade Thompson  3 , Taline Boghossian  4 , Lisa Pizzola  5 , Farah Joy Rashid  4 , Carlos Rojas-Fernandez  6 , Kate Walsh  7 , Vivian Welch  8 , Paul Moayyedi  9
Affiliations
Practice Guideline

Deprescribing proton pump inhibitors: Evidence-based clinical practice guideline

Barbara Farrell et al. Can Fam Physician. 2017 May.

Abstract

Objective: To develop an evidence-based guideline to help clinicians make decisions about when and how to safely taper or stop proton pump inhibitors (PPIs); to focus on the highest level of evidence available and seek input from primary care professionals in the guideline development, review, and endorsement processes.

Methods: Five health professionals (1 family physician, 3 pharmacists, and 1 gastroenterologist) and 5 nonvoting members comprised the overall team; members disclosed conflicts of interest. The guideline process included the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach, with a detailed evidence review in in-person, telephone, and online meetings. Uniquely, the guideline development process included a systematic review of PPI deprescribing trials and examination of reviews of the harm of continued PPI use. Narrative syntheses of patient preferences and resource-implication literature informed recommendations. The team refined guideline content and recommendation wording through consensus and synthesized clinical considerations to address common front-line clinician questions. The draft guideline was distributed to clinicians and then to health care professional associations for review and revisions made at each stage. A decision-support algorithm was developed in conjunction with the guideline.

Recommendations: This guideline recommends deprescribing PPIs (reducing dose, stopping, or using "on-demand" dosing) in adults who have completed a minimum of 4 weeks of PPI treatment for heartburn or mild to moderate gastroesophageal reflux disease or esophagitis, and whose symptoms are resolved. The recommendations do not apply to those who have or have had Barrett esophagus, severe esophagitis grade C or D, or documented history of bleeding gastrointestinal ulcers.

Conclusion: This guideline provides practical recommendations for making decisions about when and how to reduce the dose of or stop PPIs. Recommendations are meant to assist with, not dictate, decision making in conjunction with patients.

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Figures

Figure 1
Figure 1
Proton Pump Inhibitor (PPI) Deprescribing Algorithm
Figure 1
Figure 1
Proton Pump Inhibitor (PPI) Deprescribing Algorithm
See this image and copyright information in PMC

Comment in

  • Approach to GERD.
    Ginzburg VE. Ginzburg VE. Can Fam Physician. 2017 Aug;63(8):595. Can Fam Physician. 2017. PMID: 28807948 Free PMC article. No abstract available.

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