Farrell Barbara, Pottie Kevin, Thompson Wade, Boghossian Taline, Pizzola Lisa, Rashid Farah Joy, Rojas-Fernandez Carlos, Walsh Kate, Welch Vivian, Moayyedi Paul
Assistant Professor in the Department of Family Medicine at the University of Ottawa in Ontario, Adjunct Assistant Professor in the School of Pharmacy at the University of Waterloo in Ontario, and Scientist at the Bruyère Research Institute at the University of Ottawa.
Associate Professor in the Department of Family Medicine and the School of Epidemiology, Public Health and Preventive Medicine at the University of Ottawa and Scientist at the Bruyère Research Institute.
Can Fam Physician. 2017 May;63(5):354-364.
To develop an evidence-based guideline to help clinicians make decisions about when and how to safely taper or stop proton pump inhibitors (PPIs); to focus on the highest level of evidence available and seek input from primary care professionals in the guideline development, review, and endorsement processes.
Five health professionals (1 family physician, 3 pharmacists, and 1 gastroenterologist) and 5 nonvoting members comprised the overall team; members disclosed conflicts of interest. The guideline process included the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach, with a detailed evidence review in in-person, telephone, and online meetings. Uniquely, the guideline development process included a systematic review of PPI deprescribing trials and examination of reviews of the harm of continued PPI use. Narrative syntheses of patient preferences and resource-implication literature informed recommendations. The team refined guideline content and recommendation wording through consensus and synthesized clinical considerations to address common front-line clinician questions. The draft guideline was distributed to clinicians and then to health care professional associations for review and revisions made at each stage. A decision-support algorithm was developed in conjunction with the guideline.
This guideline recommends deprescribing PPIs (reducing dose, stopping, or using "on-demand" dosing) in adults who have completed a minimum of 4 weeks of PPI treatment for heartburn or mild to moderate gastroesophageal reflux disease or esophagitis, and whose symptoms are resolved. The recommendations do not apply to those who have or have had Barrett esophagus, severe esophagitis grade C or D, or documented history of bleeding gastrointestinal ulcers.
This guideline provides practical recommendations for making decisions about when and how to reduce the dose of or stop PPIs. Recommendations are meant to assist with, not dictate, decision making in conjunction with patients.
制定一份循证指南，以帮助临床医生决定何时以及如何安全地逐渐减少或停用质子泵抑制剂（PPI）；聚焦于现有最高水平的证据，并在指南制定、审查和认可过程中征求初级保健专业人员的意见。
五名卫生专业人员（1名家庭医生、3名药剂师和1名胃肠病学家）和五名无投票权成员组成了整个团队；成员披露了利益冲突。该指南制定过程采用了GRADE（推荐分级评估、制定和评价）方法，在面对面、电话和在线会议中进行了详细的证据审查。独特的是，指南制定过程包括对PPI减药试验的系统评价以及对持续使用PPI危害的综述检查。患者偏好和资源影响文献的叙述性综合为推荐提供了依据。团队通过共识完善了指南内容和推荐措辞，并综合了临床考虑因素以解决一线临床医生常见的问题。指南草案分发给临床医生，然后分发给医疗保健专业协会进行各阶段的审查和修订。同时还结合指南开发了一个决策支持算法。
本指南建议，对于因烧心或轻至中度胃食管反流病或食管炎接受了至少4周PPI治疗且症状已缓解的成年人，停用PPI（减少剂量、停药或采用“按需”给药）。这些推荐不适用于患有或曾患有巴雷特食管、C级或D级严重食管炎或有记录的胃肠道溃疡出血病史的患者。
本指南为决定何时以及如何减少PPI剂量或停药提供了实用建议。这些建议旨在协助而非决定与患者共同做出的决策。
