CLINICAL AND SYSTEMATIC REVIEWS: REVIEWDiscontinuing Long-Term PPI Therapy: Why, With Whom, and How?Targownik, Laura MD, MSHS, FRCPC1Author Information 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: firstname.lastname@example.org published online 20 March 2018 American Journal of Gastroenterology: April 2018 - Volume 113 - Issue 4 - p 519-528 doi: 10.1038/ajg.2018.29 Buy Metrics Abstract 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?). © The American College of Gastroenterology 2018. All Rights Reserved.