Been on an Acid Reducer for Years?What Guidance Says About Stepping Down

Maybe you started a proton pump inhibitor (PPI) such as omeprazole for a bad stretch of heartburn, a stomach ulcer or a hospital stay. Years later, it’s still on your list. PPIs are among the most used medicines in the world, and they’re increasingly taken for reasons where the benefit is less certain.¹ A 2022 American Gastroenterological Association (AGA) expert review gives advice on when stopping or stepping down makes sense.¹

Start with “why am I taking this?”

The review says everyone on a PPI should have a regular check of why they’re taking it, with the reason written down, and that this is the job of the primary care clinician.¹ If there’s no clear reason for long-term use, a trial of stopping should be considered.¹ People taking a PPI twice a day for a good reason may be able to step down to once a day.¹

Who usually should stay on it

The review says stopping is generally not advised for people with:¹

• complicated reflux, such as severe erosive esophagitis, an esophageal ulcer or a narrowing (stricture)
• Barrett’s esophagus or eosinophilic esophagitis
• idiopathic pulmonary fibrosis, a lung disease
• a high risk of bleeding in the upper digestive tract

Your clinician should check your bleeding risk before you stop, which matters if you take aspirin or blood thinners.¹

Expect some rebound

After long-term use, stopping can bring a temporary flare of heartburn or indigestion as the stomach briefly makes extra acid.¹ Your clinician may suggest tapering the dose or stopping all at once; the review says either can work.¹ Knowing this ahead of time can keep a short flare from sending you straight back to daily pills.

Side effect headlines are not the reason

You may have read about possible links between long-term PPIs and other health problems. The review says the decision to stop should rest on whether you still need the medicine, not on worry about those possible side effects.¹ If you need a PPI, that need comes first.

If you buy it over the counter

Store-bought omeprazole is labeled for frequent heartburn, two or more days a week, as a 14-day course that can be repeated every 4 months unless a doctor directs otherwise.² The label says to ask a doctor before use if you’ve had heartburn for more than 3 months, and not to use it if you have trouble swallowing, vomit blood or have black or bloody stools.² Our guide to the heartburn aisle compares PPIs with antacids and H2 blockers.

Questions to ask

1. Why did I start this, and do I still need it?
2. Could I step down to a lower dose, every other day, or as needed?
3. Is my bleeding risk a reason to stay on it?
4. What should I do if heartburn flares after I stop?

Our articles on heartburn versus GERD and raising the head of the bed cover other steps.

Try: “I’ve taken omeprazole every day for six years. Can we look at whether I still need it, and plan how to come off it if I don’t?”

Bloated by Dinner includes a Belly Clock log and a Test-It list with a visit script. Use them to track heartburn before and after any dose change. See the book.