A new clinical study by UZ Leuven provides GPs with a scientifically supported tapering schedule to safely reduce the overuse of PPIs. In most cases, stomach symptoms do not return, and patients often even report feeling better overall. The findings aim to give doctors practical guidance to tackle the widespread overuse of these medicines in our country.
More than seven out of ten patients who have been taking PPIs daily for years manage to stop taking them completely after one year. This is the finding of UZ Leuven’s PEPPER study, commissioned and funded by the Federal Health Care Knowledge Centre (KCE). The researchers followed 628 patients from Belgian general practices who had been taking the medication for an average of nine years. Until now, attempts to stop taking PPIs have often failed, but the new clinical data show that gradual tapering under a GP’s supervision succeeds far more often than previously thought.
Many people think they’ll have to take their PPI for the rest of their lives.
prof. dr. Jan Tack
Belgium among Europe’s leading PPI users
Belgium has ranked among Europe’s leading countries for PPI use for years. Almost three in ten Belgians receive at least one prescription each year, and around four in ten long-term users continue taking a high dose that is actually intended for no more than about two months. This overuse costs the healthcare system around €120 million a year, and prolonged use can also carry health risks. Stopping abruptly is no solution either, as it often causes a severe rebound in stomach acid production, prompting many people to quickly turn to the pills again.
In the PEPPER study, the researchers compared three specific tapering strategies. The first is the conventional tapering schedule known as intermittent use: patients take the medication every other day, then every third day, and finally twice a week before stopping completely. The second approach is ‘on-demand’ use: patients stop immediately and, for one month, take a PPI only when symptoms occur. Once the symptoms disappear, they stop taking it again. In the third strategy, patients switch to an alginate: a preparation based on seaweed extract and neutralising salts that protects against stomach acid, which they take as an alternative when symptoms arise.
Less bloating
The second approach, ‘on-demand’ use, produced the best results, closely followed by the strategy using alginates as a substitute. At the end of the one-year study, between 67 and 73 per cent of patients across the three groups had completely stopped taking PPIs regularly. More than 40 per cent had barely needed any PPIs throughout the entire year. Quality of life was also maintained: after a short adjustment period, patients actually reported fewer symptoms such as bloating. Doctors also observed increased iron and vitamin B12 levels in the participants’ blood.
The findings will help doctors support patients who have been taking PPIs for a long time to safely reduce or stop their medication. At the same time, the study makes clear that stopping is not feasible for everyone: 30 to 40 per cent of patients do need ongoing PPI treatment to keep stomach symptoms and, in some cases, damage to the oesophagus or stomach under control.
Professor Jan Tack, gastroenterologist at UZ Leuven and principal investigator: “Many people think that once they start taking a PPI, they will have to take it for the rest of their lives. Our results clearly show, however, that seven out of ten long-term users can manage perfectly well without it, even after an average of nine years of daily use. With the right support and a tailored tapering plan supervised by their GP, symptoms disappear and people even feel better. This gives GPs scientifically supported guidance to break the cycle of chronic prescription.”
Frank Vandenbroucke, Federal Minister of Social Affairs and Public Health: “We have long been raising the alarm about the excessive use of PPIs in Belgium. This UZ Leuven study demonstrates that our ambition to reduce this overuse is not only urgently needed but also entirely achievable in practice, without compromising quality of care for the patient. By giving GPs clear guidance, we can save millions of euros in unnecessary spending and reinvest those resources in care where they make a real difference.”
About the PEPPER study
The PEPPER study was commissioned and funded by the Federal Health Care Knowledge Centre (KCE) as part of its practice-oriented clinical research programme. The project was coordinated by a team at UZ Leuven, in close collaboration with Belgium’s seven academic centres for general practice and dozens of general practices across the country. The study aimed to identify a scientifically supported, feasible strategy that would enable GPs to safely taper long-term PPI use in patients without a clear medical need for ongoing treatment.
The results of the PEPPER study will be presented on 15 October at an academic symposium in Leuven. The study was also selected as one of ten leading studies for the plenary session at United European Gastroenterology (UEG) Week in Barcelona in October.