Proton pump inhibitors (PPIs) are the first line of treatment for peptic ulcer and gastroesophageal reflux disease (GERD). Current national guidelines state that chronic PPI therapy is indicated for esophagitis grade C and D, for Barrett’s esophagus, Zollinger-Ellison syndrome, or to prevent bleeding ulcers with chronic NSAID intake in at-risk patients. In primary care, guidelines propose empiric short-term PPI therapy during a maximum of 8 weeks to control symptoms, confirming a putative GERD diagnosis, followed by PPI therapy interruption. Yet, the available data suggest insufficient occurrence of down-titration and/or cessation. Moreover, PPIs are also used for treatment of dyspeptic symptoms and a number of other non-gastrointestinal indications, such as ear-nose-throat and pulmonary symptoms, or to protect the stomach in case of polypharmacy intake. As such, concerns have emerged about the considerable impact of PPIs on the healthcare budget, and an increasing number of risks and side effects associated with chronic use. An ongoing national study, the PEPPER trial, aims to provide quality evidence to determine the most effective strategy for stopping chronic PPI intake in patients for whom there is no firm medical indication for their continued use
Keywords
Proton pump inhibitors, peptic ulcer, gasto-esophageal reflux disease