Too Much PPI Use?

Proton-pump inhibitors (PPIs) are used for the long-termmanagement of gastroesophageal reflux disease (GERD).Originally approved for the treatment of erosive esophagitis,they also are commonly used to treat patients with nonerosivereflux disease. In a recent issue of Alimentary Pharmacologyand Therapeutics, Thomas J. Lee, MD, and colleaguesaddressed the potential overuse of these agents.Their review of the literature included observational studiesand randomized controlled trials that assessed the ability ofpatients'symptoms to be adequately controlled by lessaggressive PPI treatment.

A significant number of patients had adequate symptomcontrol when the daily PPI regimen was reduced in dosage(eg, 40 mg reduced to 20 mg) or when the dosage regimenwas changed from daily to intermittent (every other day) oron-demand treatment. Studies indicated that, once symptomswere controlled, PPI therapy could be substituted withhistamine H₂A receptor antagonist therapy while maintaininga high degree of patient-reported satisfaction with efficacy.Physicians should consider the cost benefit and evaluatewhich of their GERD patients could be managed onreduced PPI therapy.