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New Guidance on Proton Pump Inhibitors (PPIs)

The American Gastroenterological Association has issued new guidance for prescribing proton pump inhibitors (PPIs).

The 10 best practice recommendations are as follows

  1. For all patients on PPIs, primary care physicians should conduct a regular review of ongoing indications for use and document any indication for continued use.
  2. De-prescribing should be considered for any patients on chronic PPIs without a definitive indication.
  3. The majority of patients on twice-daily PPI dosing should be considered for once-daily step-down dosing.
  4. PPIs should not be discontinued for those with complicated GERD, including patients with a prior history of severe peptic structure, esophageal ulcers, or erosive esophagitis,
  5. A trial of PPI de-prescribing should also not be considered for those with eosinophilic esophagitis, idiopathic pulmonary fibrosis, or Barrett’s esophagus, where it has been shown to lower the risk of esophageal adenocarcinoma
  6. Physicians should use an evidence-based strategy assessing the risk of upper GI bleeding before a trial of de-prescribing — patients at risk may include those with a history of such bleeds and those on multiple antithrombotics, among others.
  7. If patients are at high risk for upper GI bleeds, such as those with the rare Zollinger-Ellison syndrome, PPIs should not be discontinued.
  8. Due to rebound acid hypersecretion, physicians should advise those discontinuing long-term (over 8 weeks) PPIs of the risk of transient upper GI symptoms.
  9. Abrupt discontinuation or dose tapering can be used to de-prescribe PPIs
  10. De-prescribing decisions should be solely based on the absence of a PPI use indication – not because of concerns over potential PPI-associated adverse events.

Source: Retrieved from sciencedirect.com/science/article/pii/S001650852104083X

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