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 defic...

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. Only patients I continue indefinitely are post-ablation Barrett’s esophagus.

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 rev...