TY - JOUR T1 - Deprescribing proton pump inhibitors JF - Canadian Family Physician JO - Can Fam Physician SP - 354 LP - 364 VL - 63 IS - 5 AU - Barbara Farrell AU - Kevin Pottie AU - Wade Thompson AU - Taline Boghossian AU - Lisa Pizzola AU - Farah Joy Rashid AU - Carlos Rojas-Fernandez AU - Kate Walsh AU - Vivian Welch AU - Paul Moayyedi Y1 - 2017/05/01 UR - http://www.cfp.ca/content/63/5/354.abstract N2 - 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. ER -