In patients on long-term proton pump inhibitors for GERD with stable symptoms, do you routinely attempt discontinuation or continue indefinitely given relapse risk?

This is a good question, as we see many patients who were placed on PPIs and continued indefinitely for GERD. As this question implies, this may not be necessary, and long-term PPI use comes with risks that include C. diff. There are additional studies that suggest fractures, CKD, and nutrient deficiencies may be associated as well, but these associations are less definitive.

Long-term PPI use is largely recommended for patients who have developed Barrett's esophagus, erosive esophagitis, ulcers, or peptic stricture. If patients do not have a strong indication for long-term PPI use, then generally attempting to de-escalate or stopping is recommended.

There isn't great evidence to approach that I've seen between reducing dose vs. stopping en...

Best approach is to wean off going every other day for 2 weeks, then every third day for 1 week, then use P-cab Voquenza on demand.

For patients with GERD whose symptoms are stable and who do not have a strong long-term indication (LA grade C/D erosive esophagitis, Barrett’s with dysplasia, prior complicated ulcer/bleed or ongoing NSAID/antiplatelet bleed-risk), most major gastroenterology guidelines recommend periodic review and a trial of stopping or switching to on-demand/step-down therapy rather than automatic indefinite PPI use.

First:

• Verify why the patient is on a PPI: healing course for erosive esophagitis vs symptom control for NERD (non-erosive reflux disease), Barrett’s, prevention of NSAID-related bleeding, H. pylori post-treatment, etc.

Secondly:

If the patient is a deprescribing candidate (stable symptoms, NERD, or PPI started empirically and now resolv...