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PPI step-down — GPhC CRA MCQ

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ModerateGastro-intestinal TherapeuticsPPI 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 for advice because he wants to reduce long-term medicine use. What is the most appropriate action?

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Correct answer: B — Discuss step-down to the lowest effective dose or on-demand use

For uncomplicated GORD with symptom control, step-down to the lowest effective PPI dose or intermittent/on-demand use may be appropriate. Alarm symptoms would require referral, but none are present. Abrupt stopping may cause rebound symptoms in some patients, so a planned reduction is better. NSAIDs may worsen gastrointestinal symptoms and bleeding risk.

Reference: NICE CKS Dyspepsia; BNF