An Emulated Clinical Trial of Deprescribing Proton Pump Inhibitors in Patients With Cirrhosis

Am J Gastroenterol. 2024 Jan 1;119(1):203-205. doi: 10.14309/ajg.0000000000002462. Epub 2023 Aug 10.


Introduction: Proton pump inhibitors (PPI) are overused and carry harms in cirrhosis. Deprescribing is advocated but has not been trialed.

Methods and findings: We emulated a clinical trial using Medicare data. All patients were receiving chronic PPI therapy before a compensated cirrhosis diagnosis. We compared the risk death/decompensation over 3 years between continuous users and deprescribers. We find that PPI deprescription is associated with less ascites and that cumulative PPI use is associated with more ascites and encephalopathy. Ultimately, 71% of deprescribers restart PPIs.

Discussion: PPI deprescribing has benefits but requires ongoing support and alternative therapies for gastrointestinal symptoms.

MeSH terms

  • Aged
  • Ascites / complications
  • Deprescriptions*
  • Humans
  • Liver Cirrhosis / complications
  • Liver Cirrhosis / drug therapy
  • Medicare
  • Proton Pump Inhibitors / therapeutic use
  • United States


  • Proton Pump Inhibitors