Open AccessJournal Article
Deprescribing proton pump inhibitors: Evidence-based clinical practice guideline.
Barbara Farrell,Kevin Pottie,Wade Thompson,Taline A Boghossian,Lisa Pizzola,Farah Joy Rashid,Carlos H. Rojas-Fernandez,K Walsh,Welch,Paul Moayyedi +9 more
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TLDR
This guideline recommends deprescribing PPIs in adults who have completed a minimum of 4 weeks of PPI treatment for heartburn or mild to moderate gastroesophageal reflux disease or esophagitis, and whose symptoms are resolved.Abstract:
Objective To develop an evidence-based guideline to help clinicians make decisions about when and how to safely taper or stop proton pump inhibitors (PPIs); to focus on the highest level of evidence available and seek input from primary care professionals in the guideline development, review, and endorsement processes. Methods Five health professionals (1 family physician, 3 pharmacists, and 1 gastroenterologist) and 5 nonvoting members comprised the overall team; members disclosed conflicts of interest. The guideline process included the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach, with a detailed evidence review in in-person, telephone, and online meetings. Uniquely, the guideline development process included a systematic review of PPI deprescribing trials and examination of reviews of the harm of continued PPI use. Narrative syntheses of patient preferences and resource-implication literature informed recommendations. The team refined guideline content and recommendation wording through consensus and synthesized clinical considerations to address common front-line clinician questions. The draft guideline was distributed to clinicians and then to health care professional associations for review and revisions made at each stage. A decision-support algorithm was developed in conjunction with the guideline. Recommendations This guideline recommends deprescribing PPIs (reducing dose, stopping, or using "on-demand" dosing) in adults who have completed a minimum of 4 weeks of PPI treatment for heartburn or mild to moderate gastroesophageal reflux disease or esophagitis, and whose symptoms are resolved. The recommendations do not apply to those who have or have had Barrett esophagus, severe esophagitis grade C or D, or documented history of bleeding gastrointestinal ulcers. Conclusion This guideline provides practical recommendations for making decisions about when and how to reduce the dose of or stop PPIs. Recommendations are meant to assist with, not dictate, decision making in conjunction with patients.read more
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Peptic ulcer disease
TL;DR: Peptic ulcer disease usually occurs in the stomach and proximal duodenum and the predominant causes in the United States are infection with Helicobacter pylori and use of nonsteroidal anti-inflammatory drugs.
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Prevalence of potentially inappropriate prescribing in older people in primary care and its association with hospital admission: longitudinal study.
Teresa Pérez,Teresa Pérez,Frank Moriarty,Emma Wallace,Ronald McDowell,Ronald McDowell,Patrick Redmond,Patrick Redmond,Tom Fahey +8 more
TL;DR: It is important to determine how hospital admission may affect appropriateness of prescribing for older people and how potential adverse consequences of admission can be minimised.
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Side effects of long-term proton pump inhibitor use: a review
TL;DR: The evidence of side effects related to long-term PPI treatment is summarized and a high probability of causality seems to be established for the side effects increased risk of gastrointestinal infections and rebound acid hypersecretion following discontinuation of treatment due to secondary hypergastrinaemia.
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Proton Pump Inhibitors and the Kidney: Implications of Current Evidence for Clinical Practice and When and How to Deprescribe
TL;DR: Evidence linking PPI use with adverse events in general and adverse kidney outcomes in particular is summarized, the impact of this evidence on patients' perception of risk is reviewed, and recommendations on how to approach P PI use and deprescription are provided.
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Self-efficacy for deprescribing: A survey for health care professionals using evidence-based deprescribing guidelines
Barbara Farrell,Barbara Farrell,Lisa Richardson,Lalitha Raman-Wilms,David de Launay,Mhd Wasem Alsabbagh,James Conklin +6 more
TL;DR: Investigation showed an increase in non‐class specific scores, with a more profound effect for clinicians in LTC where guidelines were routinely used, and a self‐efficacy assessment tool provides a novel approach to evaluating usefulness of polypharmacy management initiatives.
References
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TL;DR: Whether to test for H. pylori in patients with functional dyspepsia, gastroesophageal reflux disease (GERD), patients taking nonsteroidal antiinflammatory drugs, with iron deficiency anemia, or who are at greater risk of developing gastric cancer remains controversial.
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Guidelines for prevention of NSAID-related ulcer complications
TL;DR: These guidelines were developed under the auspices of the American College of Gastroenterology by a committee of experts in the field, reviewed by its Practice Parameters Committee, and approved by the Board of Trustees to be considered valid at the time of production based on the data available.