Assessing Frequency and Appropriateness of Proton Pump Inhibitor Deprescription in Patients Requiring Endoscopic Therapy for Esophageal Strictures

Objective: There have been concerns about the widespread usage of proton pump inhibitors (PPIs), leading to recommendations to deprescribe PPIs in certain patients. This study aims to determine if PPI deprescription in patients with symptomatic esophageal strictures was consistent with published guidelines and to compare the rate of PPI deprescription between two-time points. Methods: All patients from two gastroenterology practices who received endoscopic dilation to treat symptomatic strictures between the years of 2015-2017 and 2019-2021 were identified using physician billing codes. We defined inappropriate PPI deprescription as: a patient who was deprescribed their PPI with a past medical history of esophageal stricture, Barrett's esophagus, grade C/D esophagitis, or who had experienced symptom recurrence after PPI deprescription. Furthermore, we analyzed the rate of PPI deprescription between two time periods 2015-2017 (group 1) and 2019-2021 (group 2). Results: Two hundred twenty-three esophageal dilations were analyzed. Twenty-six patients in the sample were deprescribed their PPI, with the majority (57 percent) meeting the criteria for inappropriate PPI deprescription. There was a trend towards more inappropriate deprescription in the second time period. (71 percent vs. 33 percent; P = 0.06). Patients in group 2 had a higher rate of PPI deprescription (23.9 percent) than group 1 (6.0 percent; P < 0.001). Conclusions: PPI deprescription in patients treated for symptomatic esophageal strictures appears to be more common in the second time period. Most patients were defined as inappropriate deprescription. Physicians must apply guidelines carefully when considering deprescribing PPIs.