Proton pump inibitors (PPIs) is a class of medications that reduce the acid secretion in the
stomach. These medications are very effective to relieve symptoms of acid reflux for a
well-identified group of diseases and conditions.
Over the years, a major rise in use of these drugs has occurred. Convincing analyses reveal
that a large share of this use occurs outside regular indications, at inappropriately
elevated doses and prolonged treatment durations. Moreover, there are increasing concerns
regarding potential adverse effects and the high cost associated with improper PPI use.
Guidelines propose to reduce chronic use of PPIs, but to date this has not generated a
reduction in their application in clinical practice. One reason is the occurrence of a period
of 2 weeks of increased acid secretion, with recurrence of symptoms, when these drugs are
stopped after already a few weeks of usage (rebound effect). The best strategy to overcome
this period of increased acid secretion and symptoms has not been established.
The PEPPER study will evaluate two different strategies to overcome the period of increased
secretion when trying to interrupt chronic proton pump inhibitor therapy. The investigators
will compare the success of stopping PPIs when these strategies are implemented, compared to
a classical strategy of stopping after intermittent PPI intake. The strategies under
evaluation are a period of non-daily intake of proton pump inhibitors (on-demand) before
stopping, or the use of alternative methods to control gastric acidity and reflux (so-called
alginates).
The investigators will evaluate the success rate of stopping chronic PPIs treatment with
these approaches, compared to an interruption with intake of antacids. Patients will be
followed up for 1 year after interruption of PPIs, and the level of symptom control, quality
of life and healthcare costs will be evaluated at intervals.
The study will be conducted in patients from primary care practices with chronic PPIs intake
outside of the established disease indications.