Proton Pump Inhibitors: Rational Use and Use-Reduction - The Windsor Workshop.

Edoardo V Savarino, Foteini Anastasiou, Hashem B El Serag, Daniel Sifrim, Rena Yadlapati, Albert J Bredenoord, Juan Mendive, Peter Kahrilas, Joachim Labenz, Mihaela Udrescu, A Pali Hungin

Journal: Digestive diseases (Basel, Switzerland) 2024;42(3):211-220

PMID: 38513623

Free Full Text on S. Karger AG, Basel, Switzerland View on PubMed

Abstract

BACKGROUND

Despite deprescribing initiatives to curb overutilization of proton pump inhibitors (PPIs), achieving meaningful reductions in PPI use is proving a challenge.

SUMMARY

An international group of primary care doctors and gastroenterologists examined the literature surrounding PPI use and use-reduction to clarify: (i) what constitutes rational PPI prescribing; (ii) when and in whom PPI use-reduction should be attempted; and (iii) what strategies to use when attempting PPI use-reduction.

KEY MESSAGES

Before starting a PPI for reflux-like symptoms, patients should be educated on potential causes and alternative approaches including dietary and lifestyle modification, weight loss, and relaxation strategies. When commencing a PPI, patients should understand the reason for treatment, planned duration, and review date. PPI use at hospital discharge should not be continued without a recognized indication for long-term treatment. Long-term PPI therapy should be reviewed at least annually. PPI use-reduction should be based on the lack of a rational indication for long-term PPI use, not concern for PPI-associated adverse events. PPI use-reduction strategies involving switching to on-demand PPI or dose tapering, with rescue therapy for rebound symptoms, are more likely to succeed than abrupt cessation.

Address: Division of Gastroenterology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.; 4th Local Primary Care Team, Municipality Practice and Academic Practice of Heraklion, Crete, Greece.; Department of Gastroenterology, Amsterdam University Medical Centers, Amsterdam, The Netherlands.; Department of Medicine, Baylor College of Medicine, Houston, Texas, USA.; Department of Internal Medicine, Jung-Stilling-Hospital, Siegen, Germany.; La Mina Primary Care Academic Centre, Catalan Health Institute, University of Barcelona, Barcelona, Spain.; Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy.; Wingate Institute of Neurogastroenterology, Queen Mary University of London, London, UK.; Individual Family Practice, Bucharest, Romania.; Division of Gastroenterology, University of California San Diego, La Jolla, California, USA.; Faculty of Medical Sciences, Professor Emeritus, Primary Care and General Practice, Newcastle University, Newcastle upon Tyne, UK.

DOI: 10.1159/000538399

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MeSH Terms: Proton Pump Inhibitors, Humans, Gastroesophageal Reflux