Evidence map›Paper›PMID 42043530›Full record

Trial reportJournal of gastroenterology2026

Immediate discontinuation versus gradual tapering of proton pump inhibitors in long-term users: a randomized controlled trial.

Mariko Hojo, Kumiko Ueda, Hiroya Ueyama, Tsutomu Takeda, Shotaro Oki, Daiki Abe, Kei Nomura, Takashi Murakami, Dai Ishikawa, Yuji Shimada and 5 more

Abstract readRandomized Controlled TrialMulticenter StudyComparative Study
PubMed Publisher
In one paragraph

Trial report in Journal of gastroenterology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

15 authors.

Mariko HojoDepartment of Gastroenterology, Faculty of Medicine, Juntendo University, Bunkyo-ku, Tokyo, Japan. mhojo@juntendo.ac.jp.ORCID 0000-0001-9671-5585
Kumiko UedaDepartment of Gastroenterology, Faculty of Medicine, Juntendo University, Bunkyo-ku, Tokyo, Japan.
Hiroya UeyamaDepartment of Gastroenterology, Faculty of Medicine, Juntendo University, Bunkyo-ku, Tokyo, Japan.
Tsutomu TakedaDepartment of Gastroenterology, Faculty of Medicine, Juntendo University, Bunkyo-ku, Tokyo, Japan.
Shotaro OkiDepartment of Gastroenterology, Faculty of Medicine, Juntendo University, Bunkyo-ku, Tokyo, Japan.
Daiki AbeDepartment of Gastroenterology, Faculty of Medicine, Juntendo University, Bunkyo-ku, Tokyo, Japan.
Kei NomuraDepartment of Gastroenterology, Faculty of Medicine, Juntendo University, Bunkyo-ku, Tokyo, Japan.
Takashi MurakamiDepartment of Gastroenterology, Faculty of Medicine, Juntendo University, Bunkyo-ku, Tokyo, Japan.
Dai IshikawaDepartment of Gastroenterology, Faculty of Medicine, Juntendo University, Bunkyo-ku, Tokyo, Japan.
Yuji ShimadaDepartment of Gastroenterology, Juntendo University Shizuoka Hospital, Izunokuni-Shi, Shizuoka, Japan.
Daisuke AsaokaDepartment of Gastroenterology, Juntendo Tokyo Koto Geriatric Medical Center, Koto-ku, Tokyo, Japan.
Ryunosuke OkaharaJuntendo Clinical Research and Trial Center, Juntendo University Hospital, Bunkyo-ku, Tokyo, Japan.
Shuko NojiriJuntendo Clinical Research and Trial Center, Juntendo University Hospital, Bunkyo-ku, Tokyo, Japan.
Tomoyoshi ShibuyaDepartment of Gastroenterology, Faculty of Medicine, Juntendo University, Bunkyo-ku, Tokyo, Japan.
Akihito NagaharaDepartment of Gastroenterology, Faculty of Medicine, Juntendo University, Bunkyo-ku, Tokyo, Japan.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundProton pump inhibitors (PPIs) are often continued after symptoms have improved, despite no clear indications for maintenance therapy. Although unnecessary long-term PPI use should be avoided, concerns about symptom rebound after discontinuation frequently discourage withdrawal; evidence comparing discontinuation strategies remains insufficient.

methodsWe conducted a multicenter, randomized, parallel-group trial comparing immediate discontinuation and gradual tapering of PPIs, including PCABs, in clinically stable outpatients with gastroesophageal reflux disease receiving long-term PPI therapy. Participants were randomized 1:1 to abrupt discontinuation or dose reduction to half for 2 weeks followed by discontinuation. Rescue PPI use was permitted as needed. Successful discontinuation was defined as ≤ 8 days of rescue PPI use during each 28-day assessment window. The primary outcome was successful discontinuation at 24 weeks, and the secondary outcome was successful discontinuation at 48 weeks. Analyses were performed primarily in the intention-to-treat population.

resultsSixty-three participants were randomized. At 24 weeks, successful discontinuation was achieved in 74.2% of the immediate discontinuation group and 75.0% of the gradual taper group (risk difference: - 0.008, 95% CI: - 0.231 to 0.215). Results were similar at 48 weeks and in per-protocol analyses. No protocol-specified adverse events were observed. On exploratory analyses, older age and lower baseline regurgitation score were associated with successful discontinuation. Rescue medication use occurred early after discontinuation but did not preclude long-term success.

conclusionsImmediate discontinuation and gradual tapering resulted in comparable rates of successful PPI withdrawal in clinically stable patients. Counseling regarding transient symptoms and on-demand rescue therapy may facilitate successful discontinuation regardless of strategy.

Indexed as

Drug TaperingGastroesophageal RefluxProton Pump InhibitorsAgedDrug Administration ScheduleFemaleHumansMaleMiddle AgedTime FactorsTreatment InterruptionTreatment OutcomeProton Pump InhibitorsDiscontinuationProton pump inhibitorsRescue medicationTapering

Identifiers

PMID42043530

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.