An Emulated Clinical Trial of Deprescribing Proton Pump Inhibitors in Patients With Cirrhosis.

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.

Citation

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

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PMID: 37561055

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