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 18 January 2018

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News

Step-down from multiple- to single-dose proton pump inhibitors

Patients with gastroesophageal reflux disease who are asymptomatic on multiple-dose PPIs can be stepped-down to single-dose PPIs without symptom recurrence, find physicians in the September issue of the American Journal of Gastroenterology.

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The management costs for gastroesophageal reflux disease are high due to the expensive medications used for maintenance therapy.

Previous studies have shown that patients can successfully step-down from proton pump inhibitors (PPIs) to less expensive therapy once their symptoms have reduced.

In this study, physicians from the United States investigated whether patients could step-down from multiple dose PPIs to single-dose PPIs. The team also assessed whether this decreased costs or adversely influenced patients' quality of life.

They evaluated 117 consecutive patients in whom PPIs had completely alleviated reflux symptoms.

80% of patients successfully stepped-down to single-dose PPIs.
American Journal of Gastroenterology

All eligible subjects completed demographic information and quality-of-life surveys, then they were stepped-down to single-dose PPIs; either lansoprazole (30 mg daily) or omeprazole (20 mg daily).

The physician followed-up these patients for 6 months, or until subjects reported recurrence of symptoms. If symptoms returned PPIs were reinstituted at the dose that had originally alleviated the subjects' symptoms.

The team measured the proportion of patients who successfully stepped-down to single-dose PPIs.

The physicians found that 80% of patients successfully stepped-down to single-dose PPIs.

However, they determined that greater the duration of PPI use prior to study enrollment, the more likely reflux symptoms would recur on the single-dose PPIs.

They also found that although quality of life was not altered with the step-down, dyspepsia increased.

The overall costs of gastroesophageal reflux management were reduced.

Dr John Inadomi's team concluded, "The majority of patients rendered asymptomatic on greater than single-dose PPI might be subsequently stepped-down to single-dose therapy without recurrence of reflux-type symptoms".

"This intervention can decrease management costs without adversely affecting quality of life".

Am J Gastroenterol 2003; 98(9): 1940-4
22 September 2003

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