Proton pump inhibitors (PPI) are overused and carry harms in cirrhosis. Deprescribing is advocated but has not been trialed. We emulated a clinical trial using Medicare data. All patients were receiving chronic PPI therapy before a compensated cirrhosis diagnosis. We compared the risk death/decompensation over 3 years between continuous users and deprescribers. We find that PPI deprescription is associated with less ascites and that cumulative PPI use is associated with more ascites and encephalopathy. Ultimately, 71% of deprescribers restart PPIs. PPI deprescribing has benefits but requires ongoing support and alternative therapies for gastrointestinal symptoms. Copyright © 2023 by The American College of Gastroenterology.
Elliot B Tapper, Zhe Zhao, Neehar D Parikh. An Emulated Clinical Trial of Deprescribing Proton Pump Inhibitors in Patients With Cirrhosis. The American journal of gastroenterology. 2024 Jan 01;119(1):203-205
PMID: 37561055
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