Digestive health

Long-term reflux medication: when should treatment be reviewed?

Proton pump inhibitors (PPIs) are effective medicines for gastro-oesophageal reflux disease, peptic ulcer disease and several other acid-related conditions. For many people they are entirely appropriate. The important question is whether the original reason for treatment still applies and whether the dose remains appropriate.

Long-term PPI use has been associated in observational studies with several possible adverse effects. These studies do not, by themselves, prove that PPIs directly cause those outcomes. Treatment should therefore be reviewed thoughtfully rather than stopped simply because a medicine has been taken for a long time.

When review may be useful

• Your reflux symptoms remain troublesome despite treatment.
• Symptoms return whenever medication is reduced or stopped.
• You have difficulty swallowing, unexplained weight loss, bleeding, anaemia or persistent vomiting.
• The medicine was started empirically and the ongoing indication is uncertain.
• You have been advised to consider further investigation such as gastroscopy.

Some patients have clear reasons to remain on long-term acid suppression, including particular complications of reflux or ulcer disease. Others may be suitable for dose reduction or cessation, usually with a plan for managing rebound symptoms and appropriate follow-up.

Do not stop prescribed medication without discussing it with the clinician responsible for your care.