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Long-term proton pump inhibitor use — USMLE Step 3 MCQ

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ModerateAmbulatory Medicine / Primary CareLong-term proton pump inhibitor useUSMLE Step 3

A 54-year-old woman has taken omeprazole daily for 5 years after an episode of uncomplicated reflux. She has no Barrett esophagus, gastrointestinal bleeding, peptic stricture, chronic NSAID use, or severe recurrent symptoms. She asks whether she needs lifelong treatment. Which of the following is the most appropriate at this time?

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

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Correct answer: D — Attempt step-down or discontinuation with symptom-guided therapy

For uncomplicated GERD controlled on chronic PPI therapy, deprescribing or step-down therapy is appropriate when there is no high-risk indication for maintenance treatment.

Reference: American Gastroenterological Association PPI deprescribing advice