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75% of indigestion patients reduce or stop PPIs after education, rescue therapy

A combination of education and short-term symptom management via rescue therapy helped most patients with dyspepsia in England either reduce proton pump inhibitor use or stop taking PPIs completely, according to findings recently published in BJGP Open.

Healio has previously reported on the mixed evidence surrounding long-term use of PPIs. Potential consequences include various forms of kidney disease, listeriosis, microbiome alterations linked to C. difficile risk and other medical conditions. Conversely, other studies have shown no link between PPI use and systolic BP and in some instances, using these agents reduced upper gastrointestinal bleeding.

“Dyspepsia guidelines recommend that patients treated with PPIs should step down to the lowest effective dose or return to self-care but rebound hyperacidity can make this difficult. Many patients continue on PPIs in the long term, which may lead to safety and financial implications,” Cathal Coyle, PhD, global medical affairs lead at Reckitt Benckiser in Berkshire, United Kingdom, and colleagues wrote.

“Evidence suggests that patients frequently persist on PPIs unnecessarily, and that PPIs are often prescribed without a clear indication. Furthermore, PPI treatment is often continued in GERD patients, even those with breakthrough symptoms and unsatisfactory symptom control,” they continued.

Researchers invited 6,249 adult patients treated with PPIs for 2 or more consecutive months and a current, active PPI prescription to a 20-minute dyspepsia clinic appointment. During this educational program — known as Dyspepsia Therapy Review and Education Programme, or DRETP — patients provided their gastrointestinal history, and nurses advised patients that indigestion symptoms could return. Eligible patients who were not previously screened for Helicobacter pylori infection underwent screening and then re-entered the program after completing eradication therapy. Patients and nurses worked together to come up with a plan to stop PPI use, and nurses provided alginate as rescue therapy. Patients who needed additional appointments were encouraged to do so.

Researchers found that after 12 months, 35.3% of the patients completely stopped taking PPIs; 34.8% reduced their use; and 5% first reduced their use and then later, completely stopped taking PPIs. Another 8.7% of patients returned to their original PPI dose.

Coyle and colleagues also reported that PPI prescriptions decreased from 89,915 to 45,880, alginate prescriptions increased from 2,405 to 6,670, and annual cost-savings on prescriptions were estimated at £31,716.30.

“A program of education and short-term rebound symptom management helped the majority of patients to successfully step down or off PPIs, significantly reducing the potential risks associated with chronic therapy,” researchers concluded. – by Janel Miller

Disclosures : Coyle reports employment by Reckitt Benckiser, the commissioner and funder of the study. Please see the study for all other authors’ relevant financial disclosures.