Introduction

Proton pump inhibitors (PPIs) are frequently used in daily clinical practice, but often without a valid indication. Strategies to identify inappropriate PPI use are widely available, although the true challenge is to discontinue PPIs in these patients without developing rebound symptoms. There is therefore a need for a tool to guide patients during this process.

Aims & Methods

We aimed to evaluate the effect of a smartphone app that provides an individualized educational approach as a tool to achieve sustained PPI discontinuation. This multicenter randomized controlled trial included adult patients on daily PPI for at least four weeks without chronic PPI indication from the outpatient clinics of Internal Medicine, Gastroenterology, Rheumatology and Nephrology in two community hospitals and one university hospital in the Netherlands. Patients were excluded in case they could not understand the study (procedures) or in case of a limited life span. Patients were randomly assigned to either the smartphone app providing timely information on PPI discontinuation (intervention group) or usual care which consisted of patients receiving a brochure explaining how to stop PPI and manage symptoms providing all information at once (control group). Primary endpoint was the discontinuation rate at 2-months follow-up, defined as self-declared intake of a maximum of one tablet in the previous 14 days. Patient recruitment has ended and we anticipate final results in August 2023. We now only present preliminary numerical data.

Results

Preliminary follow up results are based on 129 (2-months) and 99 (4-months) of 165 included patients (median age 55 y/o [IQR 46-64 y/o], 61 males [47%]). More patients succeeded to discontinue PPI use at 2-months follow-up in the intervention group: 54/62 (87%) vs. 44/67 (66%). This was also seen after 4-months follow-up: 44/55 (80%) patients in the intervention group vs. 41/61 (67%) patients in the control group.

Conclusion

A smartphone app intervention providing timely guidance in discontinuing inappropriate PPI use seems to be an effective tool to improve the discontinuation rate of inappropriate PPI use compared with a one-time information folder. These preliminary data suggest that patients are able to successfully discontinue inappropriate use of medication without the time-consuming support of a healthcare worker. (Clinical trial registration number: NCT05348252).