Gastroenterology and hepatology
Overuse of long-term proton pump inhibitors
Who needs a PPI for life, how strong the evidence for long-term harms is, interactions and test interference, a worked deprescribing plan, rebound acid hypersecretion and the PBS authority rules.
Tier 1Medical sciences concept
Written with AI assistance and fact-checked against the sources below. For exam study, not clinical decisions. How notes are made
At a glance
- PPIs are among the most dispensed medicines on the PBS, and in many patients nobody remembers why they were started. Common starting points are hospital stress-ulcer prophylaxis never stopped, "gastric protection" with no ongoing NSAID, and dyspepsia that settled years ago.
- Most long-term users can step down or stop. GESA's Choosing Wisely advice is to review long-term PPIs regularly and attempt a step-down in patients without a firm indication.
- The harms come mostly from observational data and are small in absolute terms. The best reasons to deprescribe are no indication, pill burden and interactions, not fear of dementia.
Loading the rest of the note…
Finished reading?
Sources
- Therapeutic Guidelines: Gastrointestinal (eTG complete), gastro-oesophageal reflux disease and proton pump inhibitor reviewAU/NZTherapeutic Guidelines Limited
- Changes to proton pump inhibitor restriction level (1 May 2019)AU/NZPharmaceutical Benefits Scheme, Australian Government Department of Health, 2019
- Choosing Wisely Australia: Gastroenterological Society of Australia recommendations (programme now hosted by the Commission's Better Care Everywhere initiative)AU/NZAustralian Commission on Safety and Quality in Health Care / Gastroenterological Society of Australia
- Targownik LE et al. AGA Clinical Practice Update on De-Prescribing of Proton Pump Inhibitors: Expert Review. Gastroenterology 2022;162:1334-42American Gastroenterological Association, 2022
- Farrell B et al. Deprescribing proton pump inhibitors: evidence-based clinical practice guideline. Can Fam Physician 2017;63:354-64Bruyère Research Institute (deprescribing.org), 2017
- Moayyedi P et al. Safety of proton pump inhibitors based on a large, multi-year, randomized trial of patients receiving rivaroxaban or aspirin (COMPASS). Gastroenterology 2019;157:682-91Gastroenterology, 2019
- Reimer C et al. Proton-pump inhibitor therapy induces acid-related symptoms in healthy volunteers after withdrawal of therapy. Gastroenterology 2009;137:80-7Gastroenterology, 2009
- Last updated
- 14 November 2026
What changed
- 14 November 2026 Personal emails, About story and Australian-style copy