S476 PPI Discontinuation Rates in Patients With Esophageal Strictures

Abstract

Introduction: In March 2018, Canadian physicians received notification of new guidelines encouraging PPI deprescription in most patients with GERD.1 An adverse event from PPI discontinuation is rebound acid reflux leading to esophageal stricture. This study aims to quantify the proportion of patients with esophageal strictures requiring endoscopic dilation who had previously discontinued their PPI medication before and after implementation of these new guidelines. Methods: This retrospective cohort study analyzed patients who received an esophageal dilation between the years of 2015-2017 (group 1) and 2019-2021 (group 2). The outcome of interest was the rate of PPI discontinuation between the two groups. All patients from two gastroenterology practices who received esophageal dilations to treat symptomatic strictures during these years were identified for the study using physician billing codes. Information regarding demographics, medications, and previous GI diagnoses were collected using endoscopy reports and medication records from the local hospital medical database. We defined PPI discontinuation as either a 50% dose reduction, frequency reduction or complete medication discontinuation at the time of endoscopic dilation compared to the established PPI therapy from the previous 3 months or longer. The information was coded using a standardized data sheet and entered into SPSS for data analysis. Results: Data were collected from 223 esophageal dilations. The average patient age of the sample was 58.8 years old. The sample consisted of 124 males (56%) and 99 females (44%). Patients receiving dilations from group 1 (2015-17) had a PPI discontinuation rate of 6.5% (10/152 cases). Meanwhile, patients from group 2 (2019-21) had a PPI discontinuation rate of 24% (17/71 cases). These results were statistically significant (p<0.001) following Chi-Squared analysis (Table). Conclusion: There was a higher rate of PPI discontinuation in patients undergoing esophageal dilation after new PPI deprescription guidelines were sent to physicians. PPI deprescription recommendations may have unintended consequences. Further research is necessary to understand the risks and benefits of discontinuing PPI therapy. 1- https://tinyurl.com/2p8t9a7b Table 1. - Fisher Exact test: p value <0.001 Chi-Squared PPI Discontinued PPI Non-discontinued Total Group 1 10 142 152 Group 2 17 54 71 Total 27 196 223