Rationalizing Proton Pump Inhibitor Use: Southeast Asia Consensus Recommendations

Background and Aim: Proton pump inhibitors (PPIs) are integral to managing many gastrointestinal conditions. However, the prevalent inappropriate PPI prescription across Southeast Asia (SEA) is concerning. Given the absence of locally tailored recommendations to inform clinical practice, this consensus document aims to provide recommendations for PPI rationalization to healthcare providers in the region. Methods: The SEA PPI Rationalization Working Group is steered by 14 experts practicing across Malaysia, Thailand, Singapore, Vietnam, the Philippines, and Indonesia. The experts convened to review existing evidence and develop recommendations and to conduct an anonymous voting as per the modified Delphi method. Results: Twenty statements were formulated, focusing on areas of (i) extent and impact of PPI overprescription (four statements), (ii) benefits and barriers to PPI rationalization (two statements), (iii) START/STOPP criteria for PPI (nine statements), and (iv) PPI rationalization strategies (five statements). The consensus document underscores the widespread inappropriate long-term PPI prescription across SEA, which may have adverse clinical outcomes. Although rationalizing PPI use may be beneficial, the experts acknowledge the challenges of implementing PPI rationalization. The experts also outlined specific indications to guide PPI initiation and advised regular review to rationalize a PPI when no longer indicated. This is followed by PPI rationalization strategies, including shared decision-making, prescribing alginate as a rescue therapy in gastroesophageal reflux disease, and further evaluation for reinitiation of PPI when clinically warranted. Conclusions: This consensus document serves to improve PPI prescribing and deprescribing practices in SEA and to provide recommendations on rationalization strategies.