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Discontinuing Long-Term PPI Therapy: Why, With Whom, and How?

Targownik, Laura, MD, MSHS, FRCPC1

American Journal of Gastroenterology: April 2018 - Volume 113 - Issue 4 - p 519–528
doi: 10.1038/ajg.2018.29
CLINICAL AND SYSTEMATIC REVIEWS: REVIEW
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Proton pump inhibitors (PPIs) are among the most widely used class of drugs prescribed over the long term in all of clinical medicine with 8–10% of ambulatory adults have been prescribed a PPI in the past 30 days. However, numerous studies have raised doubts about the long term safety of PPI use. The purpose of this review is threefold: (i) To provide an overview of the current evidence demonstrating associations between PPI use and adverse health outcomes and the likelihood of the associations being causal (Why?); (ii) To be able to identify long-term PPI users in whom the intensity of PPI therapy could be reduced or in whom PPIs could be eliminated outright (Who?); and (iii) To provide strategies on how to reduce or stop chronic PPI therapy while maintaining symptom control and reducing the risk for symptom or upper GI disease recurrence (How?).

1Section of Gastroenterology, Department of Internal Medicine, Max Rady School of Medicine at University of Manitoba, Winnipeg, Manitoba, Canada

Correspondence: Laura Targownik, MD, MSHS, FRCPC, Section of Gastroenterology, Department of Internal Medicine, Max Rady School of Medicine at University of Manitoba, 805G-715 McDermot Avenue, Winnipeg, Manitoba, Canada R3E 3P4. E-mail: laura.targownik@med.umanitoba.ca

published online 20 March 2018

© The American College of Gastroenterology 2018. All Rights Reserved.
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