I often struggle with the question, “When can we discontinue a PPI?” It is rarely a black and white issue in the (mostly) geriatric population I work with. Here’s a scenario that might make things a little more black and white.
She is 81 years old and has a history of GI bleeding. She has chronic atrial fibrillation and has had a history of multiple TIA’s and one CVA in the last year. She is not considered a candidate to go off warfarin therapy at this time. She also has a history of diabetes, and a previous MI for which she takes aspirin as well. This is definitely a case where it would be risky to discontinue a PPI for fear of GI bleed risk.
Patient 2 is a 75 year old male who recently had an episode of dyspepsia. Omeprazole was started about 1-2 months ago. He encountered some pain issues (injured back) prior to the dyspepsia for which he was using ibuprofen. This back pain has now resolved and he seldom uses ibuprofen (less than 1 or 2 times per month). With the rare use of ibuprofen at this time and the omeprazole likely being added due to the frequent use of ibuprofen in previous months, this is an example where we can likely get more aggressive about discontinuing the PPI.
Hopefully, while not complete, these short scenarios give you some things to consider when looking at whether to discontinue a PPI or not.
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