Title |
Strategies for Effective Discontinuation of Proton Pump Inhibitors
|
---|---|
Published in |
Current Gastroenterology Reports, May 2018
|
DOI | 10.1007/s11894-018-0632-y |
Pubmed ID | |
Authors |
Judith Kim, John W. Blackett, Daniela Jodorkovsky |
Abstract |
Proton pump inhibitors (PPIs) are effective for many conditions but are often overprescribed. Recent concerns about long-term risks have made patients re-evaluate their need to take PPIs chronically, though these population-based studies have methodological weaknesses. The goal of this review is to provide evidenced-based strategies for discontinuation of PPI therapy. Given that some patients experience rebound symptoms when abruptly stopping continuous PPI therapy due to its effect on hypergastrinemia, strategies focus on avoiding rebound. Tapering the PPI and then initiating a "step-down" approach with the use of alternative medications may be effective. "On-demand therapy" provides patients with the option to take intermittent PPI courses, reducing overall use and cost while preserving patient satisfaction. It is important for providers to consider ambulatory pH or pH/impedance testing to rule out diagnoses that may require alternative medications like neuromodulators. A number of studies reviewed here can provide guidance in counseling patients on PPI discontinuation. It is important for the provider to obtain a baseline needs assessment for PPI therapy and to elucidate predictors of difficulty in discontinuation prior to initiating a strategy. |
X Demographics
Geographical breakdown
Country | Count | As % |
---|---|---|
Spain | 11 | 28% |
United States | 7 | 18% |
Canada | 2 | 5% |
United Kingdom | 2 | 5% |
Saint Barthélemy | 1 | 3% |
France | 1 | 3% |
Venezuela, Bolivarian Republic of | 1 | 3% |
Australia | 1 | 3% |
Ireland | 1 | 3% |
Other | 0 | 0% |
Unknown | 13 | 33% |
Demographic breakdown
Type | Count | As % |
---|---|---|
Members of the public | 34 | 85% |
Scientists | 4 | 10% |
Practitioners (doctors, other healthcare professionals) | 2 | 5% |
Mendeley readers
Geographical breakdown
Country | Count | As % |
---|---|---|
Unknown | 37 | 100% |
Demographic breakdown
Readers by professional status | Count | As % |
---|---|---|
Student > Master | 7 | 19% |
Student > Bachelor | 6 | 16% |
Researcher | 5 | 14% |
Professor > Associate Professor | 4 | 11% |
Other | 3 | 8% |
Other | 5 | 14% |
Unknown | 7 | 19% |
Readers by discipline | Count | As % |
---|---|---|
Medicine and Dentistry | 17 | 46% |
Pharmacology, Toxicology and Pharmaceutical Science | 8 | 22% |
Nursing and Health Professions | 3 | 8% |
Biochemistry, Genetics and Molecular Biology | 1 | 3% |
Agricultural and Biological Sciences | 1 | 3% |
Other | 1 | 3% |
Unknown | 6 | 16% |