AGA updates guidelines of De-prescribing proton pump inhibitors
USA: A recent study published in the journal Gastroenterology, reports recent American Gastroenterological Association (AGA) clinical practice guidelines on de-prescribing of proton pump inhibitors (PPIs).
Proton pump inhibitors, developed for the treatment and prevention of acid-mediated upper gastrointestinal conditions, are the most commonly used medications across the globe. These agents are used increasingly for indications where their benefits are less certain. Overprescription of PPI imposes an economic cost and contributes to polypharmacy. Also, PPI use is increasingly being linked to a number of adverse events (PPI-associated adverse events [PAAEs]). Therefore, PPIs de-prescribing is an important strategy for lowering pill burden while reducing real costs and
The clinical update by Laura E. Targownik, University of Toronto, Toronto, Ontario, Canada, and colleagues was aimed to provide Best Practice Advice (BPA) statements about how to approach PPI de-prescribing in ambulatory patients.
Best Practice Advice Statements
Best Practice Advice 1
All patients taking a PPI should have a regular review of the ongoing indications for use and documentation of that indication. This review should be the responsibility of the patient's primary care provider.
Best Practice Advice 2
All patients without a definitive indication for chronic PPI should be considered for trial of de-prescribing.
Best Practice Advice 3
Most patients with an indication for chronic PPI use who take twice-daily dosing should be considered for step down to once-daily PPI.
Best Practice Advice 4
Patients with complicated gastroesophageal reflux disease, such as those with a history of severe erosive esophagitis, esophageal ulcer, or peptic stricture, should generally not be considered for PPI discontinuation.
Best Practice Advice 5
Patients with known Barrett's esophagus, eosinophilic esophagitis, or idiopathic pulmonary fibrosis should generally not be considered for a trial of de-prescribing.
Best Practice Advice 6
PPI users should be assessed for upper gastrointestinal bleeding risk using an evidence-based strategy before de-prescribing.
Best Practice Advice 7
Patients at high risk for upper gastrointestinal bleeding should not be considered for PPI de-prescribing.
Best Practice Advice 8
Patients who discontinue long-term PPI therapy should be advised that they may develop transient upper gastrointestinal symptoms due to rebound acid hypersecretion.
Best Practice Advice 9
When de-prescribing PPIs, either dose tapering or abrupt discontinuation can be considered.
Best Practice Advice 10
The decision to discontinue PPIs should be based solely on the lack of an indication for PPI use, and not because of concern for PAAEs. The presence of a PAAE or a history of a PAAE in a current PPI user is not an independent indication for PPI withdrawal. Similarly, the presence of underlying risk factors for the development of an adverse event associated with PPI use should also not be an independent indication for PPI withdrawal.
Reference:
"AGA Clinical Practice Update on De-Prescribing of Proton Pump Inhibitors: Expert Review," was published in the journal Gastroenterology on February 16, 2022.
