PPI Deprescribing Strategies

The trial compares on-demand PPI, alginate replacement and fixed taper strategies over an initial 1-month deprescription period. The fixed taper arm is the comparator because Belgian guidelines recommend gradual reduction and feasibility work found it common among GPs. Antacids, alginates or H2-receptor antagonists may be used to limit symptom recurrence, but H2-receptor antagonists are unavailable in Belgium for this trial. After completing the allocated strategy, patients are asked to stop PPI or alginate use completely for 1 month with rescue antacids only. Current guidance generally recommends dose reduction before stopping PPIs.