title: Strategies for discontinuation of proton pump inhibitors: a systematic review.
abstract: OBJECTIVE
  Proton pump inhibitors (PPIs) are considered to be overprescribed. Consensus on how to attempt discontinuation is, however, lacking. We therefore conducted a systematic review of clinical studies on discontinuation of PPIs.
  
  
  METHODS
  Systematic review based on clinical studies investigating discontinuation strategies and discontinuation rates for users of antisecretory medication judged eligible for withdrawal. The databases Medline, Embase and Cochrane Library were searched to December 2013 using the terms antisecretory, anti-ulcer, PPI, acid suppressant, discontinuation, step-down, step down, cessation, tapering, withdrawal and withhold. Search terms were used either singularly or in combination. Papers written in English or Scandinavian were included. Concurrent hand searching was undertaken to pursue references of references. The website ClinicalTrials.gov was searched for unpublished results and ongoing studies. A total of 371 abstracts were scrutinized to determine relevancy.
  
  
  RESULTS
  The thorough search resulted in six clinical studies on strategies for discontinuation of PPIs. All discontinuation regimens used in the studies differed, and several interventions have been tested in order to decrease use of PPIs. Discontinuations were reported across all studies ranging from 14% to 64% without deteriorating symptom control. Tapering seems to be a more effective discontinuation strategy than abrupt discontinuation.
  
  
  CONCLUSIONS
  Discontinuation of PPIs is feasible in a clinical setting, and a substantial number of the patients treated without a clear indication can safely reduce or discontinue treatment. Tapering seems to be the most effective way of doing this.
authors.affiliation: Research Unit of General Practice, Institute of Public Health, University of Southern Denmark, Odense C, Denmark and phaastrup@health.sdu.dk.
authors.forename: Peter
authors.initials: P
authors.lastname: Haastrup
authors.affiliation: Research Unit of General Practice, Institute of Public Health, University of Southern Denmark, Odense C, Denmark and.
authors.forename: Maja S
authors.initials: MS
authors.lastname: Paulsen
authors.affiliation: Research Unit of General Practice, Institute of Public Health, University of Southern Denmark, Odense C, Denmark and.
authors.forename: Luise M
authors.initials: LM
authors.lastname: Begtrup
authors.affiliation: Department of Medical Gastroenterology S, Odense University Hospital, Odense C, Denmark.
authors.forename: Jane M
authors.initials: JM
authors.lastname: Hansen
authors.affiliation: Research Unit of General Practice, Institute of Public Health, University of Southern Denmark, Odense C, Denmark and.
authors.forename: Dorte E
authors.initials: DE
authors.lastname: Jarbøl
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002986:Clinical Trials as Topic; D016206:Databases, Bibliographic; D004415:Dyspepsia / Q000188:drug therapy*; D005764:Gastroesophageal Reflux / Q000188:drug therapy*; D006801:Humans; D057970:Inappropriate Prescribing / Q000009:adverse effects* / Q000639:trends; D008875:Middle Aged; D054328:Proton Pump Inhibitors / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D028761:Withholding Treatment
chemical_list: D054328:Proton Pump Inhibitors
keywords: Dyspepsia; general practice; patient-centred care; placebos; proton pump inhibitors; withholding treatment.