The number one recommendation of the Canadian Association of Gastroenterology is
“don’t maintain long term proton pump inhibitor (PPI) therapy for gastrointestinal symptoms without an attempt to stop/reduce PPI at least once per year in most patients” (see Quick Links for more information and recommendations).
Although not commonly seen, long term PPI therapy increases risk of fractures, enteric infections including C. difficile, pneumonia, Acute Interstitial Nephritis, Vitamin B12 deficiency and hypomagnesemia, not to mention the cost of unnecessary treatment.
Also, think of the time savings of not renewing these unnecessary prescriptions!
In cases where PPIs do not have a clear ongoing indication, it is prudent to consider deprescribing.
PPI’s do cause gastrin hypersecretion, so when stopping a PPI in someone who has been on therapy for several months, there is some concern that there may be some symptomatic rebound acid secretion. This could be misinterpreted as a need for ongoing therapy. Besides lifestyle modifications, it is reasonable to taper the PPI over time, and the Choosing Wisely Canada website contains an excellent toolkit to support interventions to reduce long term PPI use (see Quick Links).
|
