Guideline sources The following summarized guidelines for the management of deprescribing proton-pump inhibitors are prepared by our editorial team based on guidelines from the American Gastroenterological Association (AGA 2022) and the College of Family Physicians of Canada (CFPC 2017). 1 2 Guidelines 1. Medical management Indications for discontinuation: consider discontinuing PPIs in all patients without a definitive indication for chronic use. E Show 2 more Considerations for discontinuation: As per AGA 2022 guidelines, assess PPI users for upper gastrointestinal bleeding risk using an evidence-based strategy before deprescribing. E Show 2 more As per CFPC 2017 guidelines: Decrease the daily dose or discontinue PPIs and change to on-demand (as needed) use in adult patients with upper gastrointestinal symptoms completed a minimum 4-week course of PPI treatment, resulting in resolution of upper gastrointestinal symptoms. B Consider prescribing an H2RA as an alternative to PPIs in adult patients with upper gastrointestinal symptoms completed a minimum 4-week course of PPI treatment, resulting in resolution of upper gastrointestinal symptoms. C https://web.pathway.md/diseases/rec3UPQpMnyaeoVab 1/2 6/29/23, 10:08 PM Deprescribing proton-pump inhibitors Pathway 2. Patient education General counseling: counsel patients discontinuing long-term PPI therapy that they may develop transient upper gastrointestinal symptoms due to rebound acid hypersecretion. E 3. Follow-up and surveillance Monitoring for indications: obtain a regular review (by the patient's primary care provider) of the ongoing indications for use and document that indication in all patients taking a PPI. E References 1. Laura E Targownik, Deborah A Fisher, Sameer D Saini. AGA Clinical Practice Update on De- Prescribing of Proton Pump Inhibitors: Expert Review. Gastroenterology. 2022 Feb 16;S0016 5085 21 04083 X. Open 2. Barbara Farrell, Kevin Pottie, Wade Thompson et al. Deprescribing proton pump inhibitors: Evidence- based clinical practice guideline. Can Fam Physician. 2017 May;63 5 354 364. Open https://web.pathway.md/diseases/rec3UPQpMnyaeoVab 2/2