SAP Primary Care
Deprescripción de inhibidores de la bomba de protones en atención primaria
By Laura Beatriz Fernández Feitó, Andrea González Llaugert, Lauren Beatriz González Claro and 3 others.
Abstract
Introduction
proton pump inhibitors (PPIs) are among the most widely used drugs worldwide, and a considerable share of long-term prescriptions lacks a documented indication or periodic review, exposing patients to avoidable risks and burdening health systems.
Objective
to critically describe the evidence on the extent of PPI overuse, the safety concerns associated with prolonged use, the rebound phenomenon after withdrawal and the deprescribing strategies applicable in primary care. Development: nearly one in four adults uses a PPI, and in primary care records most continuous users have no recorded indication. The evidence linking PPIs to adverse outcomes is mostly observational and of low certainty, while stopping a PPI can trigger transient acid-related symptoms. Interventions that combine a decision algorithm for the clinician with patient education and shared decision-making increase step-down or discontinuation; tapering or on-demand use suit mild disease, whereas complicated reflux disease, Barrett's esophagus, eosinophilic esophagitis and high gastrointestinal bleeding risk generally call for continuing therapy.