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PPI Deprescribing — ESEGH MCQ

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Moderate"Gastroenterology"PPI DeprescribingESEGH

A 47‑year‑old patient with well‑controlled gastro‑oesophageal reflux disease (GORD) on proton pump inhibitor therapy expresses concerns about long‑term adverse effects and wishes to consider deprescribing. According to current UK guidance, what is the most appropriate general approach?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: A — Use the lowest effective dose and consider discontinuation when symptoms are controlled.

Explanation lettering: B = shown as A · E = shown as B · A = shown as D · D = shown as E

According to NICE guideline CG184, in patients with GORD whose symptoms are controlled on PPI therapy, clinicians should review the continued need for treatment and step down to the lowest effective dose, offering 'as‑needed' use or attempting discontinuation when appropriate. This balanced, individualised approach addresses concerns about long‑term adverse effects while maintaining symptom control, and aligns with UK practice. Option A is overly rigid and contraindicated by guidance; C is incorrect as H2‑receptor antagonists are not superior for maintenance; D is false—long‑term PPIs may be needed in some cases; E contradicts recommendations for review and deprescribing.

Reference: NICE CG184: Gastro‑oesophageal reflux disease and dyspepsia in adults: investigation and management (2019), Recommendations