PEBC MCQ GI, Renal & Hepatic Disorders question: Canadian deprescribing guideline suggest

PEBC MCQGI, Renal & Hepatic Disorders

ER, 70, has taken pantoprazole 40 mg daily for 5 years, started for heartburn during a stressful period. She has no Barrett esophagus, bleeding history or ongoing NSAID use and has been symptom-free. What does the Canadian deprescribing guideline suggest?

a. Lower the dose or switch to on-demand use
b. Switch to famotidine 40 mg twice daily for life
c. Continue it indefinitely, since stopping causes ulcers
d. Stop it abruptly and avoid all antacids afterwards

Show the answer and explanation

Answer: a. Lower the dose or switch to on-demand use

For adults who have completed at least 4 weeks of PPI therapy for mild to moderate reflux or esophagitis and are symptom-free, the deprescribing guideline recommends decreasing to a lower dose or stopping and using the PPI on demand. Patients with Barrett esophagus, severe esophagitis or a history of bleeding ulcers are excluded. Rebound symptoms can be managed with antacids or H2 blockers as needed. Source: Farrell B et al. Deprescribing proton pump inhibitors: evidence-based clinical practice guideline (Can Fam Physician 2017;63:354).

Common mistake

Continuing long-term PPIs without reassessing the indication.

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