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Medline ® Abstract for Reference 119

of 'Overview and comparison of the proton pump inhibitors for the treatment of acid-related disorders'

Discontinuation of proton pump inhibitors in patients on long-term therapy: a double-blind, placebo-controlled trial.
Björnsson E, Abrahamsson H, Simrén M, Mattsson N, Jensen C, Agerforz P, Kilander A
Aliment Pharmacol Ther. 2006;24(6):945.
BACKGROUND: The proportion of proton pump inhibitor users on long-term therapy who can discontinue proton pump inhibitor (PPI) medication without developing symptoms is unknown.
AIM: To determine the proportion of patients on long-term PPI therapy who are able to discontinue PPIs without developing symptoms.
METHODS: Patients on long-term PPIs, without a history of peptic ulcer or esophagitis underwent upper endoscopy. Patients were randomized double-blindly to taper down or continue a constant dosage of omeprazole for three weeks. Thereafter, all patients discontinued PPIs.
RESULTS: Of the 97 patients enrolled, had used PPIs for 48 months, 78% had GERD. A total of 27% did not use PPIs during the year after discontinuation, 31% of the patients randomized to tapering discontinued PPIs and 22% of those who did not could discontinue therapy (NS). Gastro-oesophageal reflux disease (GERD) patients were more prone to continue PPIs than non-GERD patients. Only 16 (21%) of GERD patients were off PPIs vs. 48% of patients without GERD (p<0.05). Serum gastrin was higher at baseline in GERD patients who resumed PPIs versus non-resumers (p<0.05). GERD and serum gastrin were independent predictors of PPI requirement.
CONCLUSIONS: Discontinuation of PPI was successful in 27% of long-term PPI users. GERD patients had more difficulty discontinuing PPIs than non-GERD patients.
Department of Internal Medicine, Section of Gastroenterology and Hepatology, Sahlgrenska University Hospital, Gothenburg, Sweden. einar.bjornsson@medic.gu.se