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PPI review and step-down — GPhC CRA MCQ

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ModerateGI TherapeuticsPPI review and step-downGPhC CRA

A 52-year-old man has taken omeprazole 20mg daily for reflux for 9 months. His symptoms are controlled, he has no dysphagia, weight loss or bleeding, and he asks whether to continue indefinitely. What is the most appropriate alternative?

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

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Correct answer: A — discuss step-down to the lowest effective dose or on-demand use with safety-netting

Long-term PPI treatment should be reviewed periodically and continued at the lowest effective dose where ongoing therapy is needed. Step-down or on-demand use may be appropriate when symptoms are controlled and no alarm features are present. Sudden stopping may cause rebound symptoms, so counselling is helpful. Metoclopramide is not a long-term reflux-prevention substitute.

Reference: BNF; NICE CKS: Dyspepsia