. 2024 Mar 21;42(3):211–220. doi: 10.1159/000538399

Table 4.

Summary of RCT evidence for PPI use-reduction strategies

Strategy for PPI use-reduction	Study description	Outcome	Results
Lowering dose	Systematic review (2017) of patients with mild to moderate GORD [10, 53]	Recurring upper GI symptoms	49% lacked symptom control with maintenance dose versus 43% continuing PPI at healing dose
	• 5 RCTs (n = 1,912)		No statistical difference
	• 12 months		RR 1.16, 95% CI: 0.93 to 1.44
Abrupt stopping	RCT of patients (aged ≥65 years) with healed oesophagitis; abrupt stopping (placebo) versus maintenance dose PPI (n = 105) [9]	Recurring upper GI symptoms	68% lacked symptom control with abrupt cessation versus 22% continuing PPI
Abrupt stopping	• 6 months	Recurring upper GI symptoms	RR 3.02, 95% CI: 1.74 to 5.24
Tapering dose and then stopping	RCT of patients using daily PPI for upper GI symptoms; tapering versus abrupt stopping (n = 97) [55]	Restarting PPI	69% restarted PPIs with tapering versus 78% stopping abruptly
Tapering dose and then stopping	12 months	Restarting PPI	Not statistically significant; no relative risk provided
On-demand PPI (stop PPI; if symptoms return, use PPI daily until symptoms controlled, then stop)	Systematic review (2017) of patients with mild to moderate GORD [9]	Recurring upper GI symptoms	16% lacked symptom control with on-demand versus 9% continuing PPI
	• 5 RCTs (n = 1,653)		RR 1.71, 95% CI: 1.31 to 2.21
	• 3–6 months		RR 1.71, 95% CI: 1.31 to 2.21
Switch to H₂RA	Systematic review (2017) of patients with reflux oesophagitis and reflux-like symptoms [10, 53]	Recurring upper GI symptoms	39% lacked symptom control when switching to H₂RA versus 21% continuing PPI
Switch to H₂RA	• 3 RCTs (n = 468)	Recurring upper GI symptoms	RR 1.92, 95% CI: 1.44 to 2.58

Table adapted from Farrell et al. [53] and Boghossian et al. [9].

CI, confidence interval; GI, gastrointestinal; H₂RA, histamine H₂-receptor antagonists; PPI, proton pump inhibitor; RCT, randomized controlled trial; RR, relative risk.