Deprescribing proton pump inhibitors: Evidence-based clinical practice guideline.

作者：Barbara J. Farrell, Kevin C Pottie, Wade Thompson, Taline A Boghossian, Lisa Pizzola, Farah Joy Rashid, Carlos H. Rojas‐Fernandez, Kate Walsh, Welch, Paul Moayyedi · 发表于：PubMed · 年份：2017 · 被引用次数：387 · 研究领域：Gastroesophageal reflux and treatments、Esophageal Cancer Research and Treatment、Potassium and Related Disorders

OBJECTIVE: To develop an evidence-based guideline to help clinicians make decisions about when and how to safely taper or stop proton pump inhibitors (PPIs); to focus on the highest level of evidence available and seek input from primary care professionals in the guideline development, review, and endorsement processes. METHODS: Five health professionals (1 family physician, 3 pharmacists, and 1 gastroenterologist) and 5 nonvoting members comprised the overall team; members disclosed conflicts of interest. The guideline process included the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach, with a detailed evidence review in in-person, telephone, and online meetings. Uniquely, the guideline development process included a systematic review of PPI deprescribing trials and examination of reviews of the harm of continued PPI use. Narrative syntheses of patient preferences and resource-implication literature informed recommendations. The team refined guideline content and recommendation wording through consensus and synthesized clinical considerations to address common front-line clinician questions. The draft guideline was distributed to clinicians and then to health care professional associations for review and revisions made at each stage. A decision-support algorithm was developed in conjunction with the guideline. RECOMMENDATIONS: This guideline recommends deprescribing PPIs (reducing dose, stopping, or using "on-demand" dosing) in adults who ...