Guideline / position statementindependent cross-checkabstract only checked★ key study I-PPI-04 in-depth review
How to stop PPIs safely (AGA 2022)
AGA Clinical Practice Update on De-Prescribing of Proton Pump Inhibitors: Expert Review.
Overview
Targownik LE et al.. Gastroenterology 2022 · PMID 35183361 · DOI 10.1053/j.gastro.2021.12.247
Stop PPIs without a definite indication; keep them in Barrett's, severe oesophagitis and high bleeding risk; expect temporary rebound.
Does the study support the specific claim? Partly · Methodological quality: moderate
Plain-language summary
Study explained simply
- What did the researchers want to find out?
De-prescribing guidance.
- How was the study done?
Expert review.
- What was actually found?
10 statements.
- What do the results mean in everyday life?
Many people can stop; some must not.
- What are the study's limitations?
Expert opinion.
- What does it say about Elawady's specific claim?
Supports overuse claim; contradicts universal ban and 'cannot stop'.
- Do the results apply to Germany and Europe?
Applicable.
Scientific in-depth review
1. Full reference
- Authors
- Targownik LE et al.
- Journal
- Gastroenterology
- Year
- 2022
- Identifier
- PMID 35183361 DOI 10.1053/j.gastro.2021.12.247
- Verification
- verified – PubMed efetch 2026-10-25
- Retracted
- no
- Corrections
- none
- Extent checked
- abstract only
- Conflicts of interest and funding
not stated in abstract
2. Research question
How to approach PPI de-prescribing in ambulatory patients
3. Study design and population
- Study design
- Guideline / position statement – Clinical practice update / expert review (AGA)
- Population
Ambulatory PPI users
- Country
USA
- Period
2022
4. Methods and endpoints
- Exposure / intervention
PPI de-prescribing
- Endpoints
Best practice advice
- Statistical methods
Non-systematic literature review; consensus
5. Actual results
- Results
BPA 1–10: document indication; trial of de-prescribing if no definitive indication; step down twice-daily; do not stop in complicated GERD, Barrett's, EoE, IPF, high UGI bleeding risk; warn about transient rebound; taper or abrupt stop both possible; decide on indication, not fear of PPI-associated adverse events.
- Absolute risks
not applicable
- Authors' conclusion
PPIs are generally safe; patients should not use them without expected benefit.
6. Strengths
- Practical
- Explicit exclusions
7. Weaknesses
- Not a systematic review; no formal evidence grading
8. Risk of bias
- Orienting tool
- none applicable
- Type of assessment
- simplified assessment (abstract only)
- Full formal assessment
- no
- Overall risk of bias
- not assessable
- Rationale
Expert opinion.
9. Assessment of the statistical interpretation
10. Relevance to the specific claim
C-PPI-06, -07, -10, -11.
11. Independent contrary findings
12. Transferability to Germany and Europe
High.
13. Overall methodological judgement
Clear guidance on when to stop and when not to.
| Multidimensional assessment | |
|---|---|
| Authenticity of the source | verified |
| Methodological quality | moderate |
| Risk of bias | not assessable |
| Precision of results | not applicable |
| Directness | direct |
| Reproducibility | unknown |
| Consistency with the overall evidence | consistent |
| Regional transferability | high |
| Adequacy of the interpretation (by the archive) | not applicable |
14. Open questions
15. Linked fact checks
- Long-term PPI use causes chronic kidney disease and excess deaths (about 45 extra deaths per 1,000 users, mainly from cardiovascular disease, kidney disease and upper gastrointestinal cancer). – Studies contradicting or limiting the claim
- After stopping a PPI, rebound acid hypersecretion can cause new heartburn and reflux symptoms, even in people who had none before. – Studies supporting the claim
- PPIs create dependency: the drug 'manufactures the disease it claims to treat', so that a short course for a passing complaint turns into chronic dependence and one 'cannot stop'. – Studies contradicting or limiting the claim
- All acid-suppressing medicines (PPIs and H2 blockers) are permanently forbidden; heartburn should stop through the diet, not through drugs. – Studies contradicting or limiting the claim
- PPIs are widely prescribed without a real indication (for example by doctors of other specialties to 'protect the stomach') and are now sold freely. – Studies supporting the claim