Discontinuation of proton pump inhibitors in patients on long-term therapy: a double-blind, placebo-controlled trial.
BACKGROUND
The proportion of proton pump inhibitor users on long-term therapy who can discontinue proton pump inhibitor (PPI) medication without developing symptoms is unknown.


OBJECTIVE
To determine the proportion of patients on long-term PPI therapy who are able to discontinue PPIs without developing symptoms.


METHODS
Patients on long-term PPIs, without a history of peptic ulcer or esophagitis underwent upper endoscopy. Patients were randomized double-blindly to taper down or continue a constant dosage of omeprazole for three weeks. Thereafter, all patients discontinued PPIs.


RESULTS
Of the 97 patients enrolled, had used PPIs for 48 months, 78% had GERD. A total of 27% did not use PPIs during the year after discontinuation, 31% of the patients randomized to tapering discontinued PPIs and 22% of those who did not could discontinue therapy (NS). Gastro-oesophageal reflux disease (GERD) patients were more prone to continue PPIs than non-GERD patients. Only 16 (21%) of GERD patients were off PPIs vs. 48% of patients without GERD (p < 0.05). Serum gastrin was higher at baseline in GERD patients who resumed PPIs versus non-resumers (p < 0.05). GERD and serum gastrin were independent predictors of PPI requirement.


CONCLUSIONS
Discontinuation of PPI was successful in 27% of long-term PPI users. GERD patients had more difficulty discontinuing PPIs than non-GERD patients.
Björnsson
E
E
Department of Internal Medicine, Section of Gastroenterology and Hepatology, Sahlgrenska University Hospital, Gothenburg, Sweden. einar.bjornsson@medic.gu.se
Abrahamsson
H
H
Simrén
M
M
Mattsson
N
N
Jensen
C
C
Agerforz
P
P
Kilander
A
A
D000368:Aged; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D004415:Dyspepsia / Q000097:blood / Q000188:drug therapy; D004791:Enzyme Inhibitors / Q000008:administration & dosage*; D005260:Female; D005755:Gastrins / Q000097:blood; D005764:Gastroesophageal Reflux / Q000097:blood / Q000188:drug therapy*; D006801:Humans; D008134:Long-Term Care; D008297:Male; D008875:Middle Aged; D009853:Omeprazole / Q000008:administration & dosage; D054328:Proton Pump Inhibitors; D011788:Quality of Life; D016896:Treatment Outcome; D028761:Withholding Treatment
D004791:Enzyme Inhibitors; D005755:Gastrins; D054328:Proton Pump Inhibitors; D009853:Omeprazole