Feasibility and determinants of deprescription of proton pump inhibitors in patients with typical reflux symptoms

Abstract

<br><b>Background and Aims:</b> Proton pump inhibitors (PPIs) are commonly used drugs in the management of reflux symptoms. These drugs are frequently overused and have side effects on long term use. The present study was undertaken to determine the feasibility and determinants of deprescription of PPI in patients with typical reflux symptoms. <b>Materials and Methods:</b> This retrospective study recruited all patients, >18 years, with heartburn and/or regurgitation of more than 3-month duration. The severity of reflux was assessed with white light endoscopy and graded as per Los Angeles classification. All patients were advised lifestyle changes, aerobic exercises for >30 min/day, and dietary modifications. Follow-up details, including symptom resolution and drug requirement, were noted at 3 months after the initial visit. <b>Results:</b> A total of 106 patients formed the study cohort (males 60, median age 43 years [range 18–72 years]). Reflux esophagitis was noted in 32 cases (30%). Of these patients, 8 (25%) had Grade A esophagitis and the remaining had Grade B or beyond. Three-fourths of the patients were prescribed once a day PPI. On follow-up at 3 months, PPI therapy was stopped completely in 58 (54.7%) cases. Thirty-two (30.2%) and 16 (15.1%) patients were on on-demand PPI and continuous low dose therapy, respectively. A significantly higher proportion of patients with reflux esophagitis (30/32, 93.75%) could stop PPI at the end of 3 months. The need for on-demand PPI and continuous low dose therapy was higher in patients with nonerosive reflux disease (14 cases, 19%). In univariate analysis, use of alcohol (<i>P</i> = 0.04), smoking (<i>P</i> = 0.0006), presence of diabetes mellitus (<i>P</i> = 0.01), and presence of hiatus on endoscopy (<i>P</i> = 0.03) were the factors significantly associated with continued use of PPI at the end of 3 months. In multivariate analysis, smoking was the only factor independently associated with the continuation of PPI use after 3 months. <b>Conclusion:</b> Deprescription of PPI was achieved in 90 cases (84.9%) at 3 months. In univariate analysis, use of alcohol, smoking, presence of diabetes mellitus, and presence of hiatus are associated with continued PPI use at 3 months. In multivariate analysis, smoking was the only factor independently associated with the continuation of PPI use after 3 months.<br>