Systematic reviewindependent cross-checkabstract checked★ key study I-PPI-103 in-depth review

Cutting down acid blockers: fewer pills, more symptoms for some

Deprescribing versus continuation of chronic proton pump inhibitor use in adults.

Overview

Boghossian TA et al.. Cochrane Database Syst Rev 2017 · PMID 28301676 · DOI 10.1002/14651858.CD011969.pub2

In six trials of people with mild reflux, switching to as-needed PPI cut pill use by about 4 pills a week but more people had uncontrolled symptoms.

Does the study support the specific claim? Partly · Methodological quality: high

Study explained simply

What did the researchers want to find out?: Assess stopping or reducing long-term PPIs.
How was the study done?: Cochrane review of RCTs.
How many people, animals or samples were studied?: 6 trials, 1758 adults.
What was actually found?: Fewer pills; more symptom relapse with on-demand use.
How large was the observed effect?: RR 1.71 lack of symptom control.
What do the results mean in everyday life?: Many can reduce PPIs; some will have more symptoms.
What are the study's limitations?: Low-quality evidence; mild GERD only.
What does it say about Elawady's specific claim?: Contradicts 'cannot stop', but shows stopping is not always easy.
Do the results apply to Germany and Europe?: Applicable.
What can explicitly not be concluded from this study?: Cannot tell long-term effects.

Authors: Boghossian TA et al.
Journal: Cochrane Database Syst Rev
Year: 2017
Identifier: PMID 28301676 DOI 10.1002/14651858.CD011969.pub2
Verification: verified – PubMed efetch 2026-10-26 + Crossref 2026-10-26
Retracted: no
Corrections: none
Extent checked: abstract only
Conflicts of interest and funding: One author received AstraZeneca-related funding to his university; another received funding for a deprescribing guideline (abstract COI)

What are the benefits and harms of deprescribing long-term PPI therapy compared with continuous use?

Study design: Systematic review – Cochrane systematic review and meta-analysis of RCTs of PPI deprescribing
Population: Adult chronic PPI users (mostly non-erosive reflux or mild LA A/B oesophagitis)
Country: International
Period: Search to November 2016
Sample size: 6 trials; 1758 participants
Inclusion and exclusion criteria: RCTs/quasi-RCTs of stopping or reducing PPI vs continuous daily use (>=28 days)

Exposure / intervention: On-demand use (5 trials) or abrupt discontinuation (1 trial)
Comparator: Continuous daily PPI
Endpoints: GI symptom control, pill burden, satisfaction, withdrawal events
Statistical methods: Random-effects meta-analysis, GRADE

Results: On-demand use: 'lack of symptom control' RR 1.71 (1.31-2.21; low-quality evidence; 5 trials, n=1653); pill burden MD -3.79 pills/week (-4.73 to -2.84; moderate quality); lower satisfaction (low quality, high heterogeneity). Abstract states 25-70% of people are prescribed PPIs inappropriately.
Absolute risks: Not reported in abstract
Authors' conclusion: In mild GERD, on-demand deprescribing may increase GI symptoms and probably reduces pill burden; insufficient data on long-term benefits and harms.

RR 1.71 CI log-symmetric (stats/C-PPI-06_07_rebound_discontinuation.py).

Shows both sides: reducing PPIs is feasible and cuts pill use, but some people get more symptoms - discomfort, not inability to stop.

Does not separate rebound from return of underlying reflux.

Applicable.

Mixed evidence for C-PPI-07; supports overuse premise of C-PPI-11.

Multidimensional assessment
Multidimensional assessment
Authenticity of the source	verified
Methodological quality	high
Risk of bias	low
Precision of results	moderate
Directness	direct
Reproducibility	unknown
Consistency with the overall evidence	mixed
Regional transferability	high
Adequacy of the interpretation (by the archive)	not applicable

Long-term deprescribing outcomes.