Strategies and Adjunctive Therapies for Proton Pump Inhibitor Deprescribing: A Comprehensive Literature Review of Withdrawal, Rebound Acid Hypersecretion, Rescue Therapy, and Complementary Approaches
Abstract
Background: Proton pump inhibitors (PPIs) are frequently continued for prolonged periods despite initially time-limited indications. Discontinuation may be complicated by recurrent symptoms and rebound acid hypersecretion (RAHS), potentially contributing to unnecessary long-term treatment. Although several deprescribing strategies have been investigated, the optimal withdrawal approach and the role of adjunctive therapies remain uncertain.
Objective: To comprehensively review strategies for reducing or discontinuing PPI therapy and to examine pharmacological, non-pharmacological, herbal, and complementary interventions that may help control symptoms during withdrawal.
Methods: A broad narrative literature search was conducted across major biomedical databases and complementary/traditional medicine sources. Evidence was organized into three pragmatic categories: direct PPI deprescribing evidence, potential bridge-therapy evidence for gastroesophageal reflux disease (GERD), and exploratory or substantially indirect evidence.
Results: Direct evidence supports several approaches to reducing PPI exposure, including abrupt withdrawal, gradual tapering, dose or frequency reduction, on-demand treatment, H2-receptor antagonist (H2RA) rescue, alginate rescue, structured education, weight reduction, and potentially diaphragmatic breathing. Direct comparisons have not established clear superiority of tapering over abrupt discontinuation for sustained cessation, although tapering may reduce symptom burden. Alginates and H2RAs have the most directly applicable evidence for symptom control during withdrawal. Several complementary interventions, including Monteverdia ilicifolia, standardized Glycyrrhiza glabra, Aloe vera, melatonin, acupuncture, and selected Chinese herbal formulations, have clinical evidence for GERD symptom control but lack direct evidence that they improve PPI withdrawal success.
Conclusions: PPI deprescribing is feasible in appropriately selected patients, but no single withdrawal protocol has been established as optimal. Management of transient symptoms and underlying reflux mechanisms may be as important as the method of PPI reduction. Bridge and rescue therapies represent an important and insufficiently studied component of deprescribing.
How to Cite This Article
Jozélio Freire DE Carvalho MD (2026). Strategies and Adjunctive Therapies for Proton Pump Inhibitor Deprescribing: A Comprehensive Literature Review of Withdrawal, Rebound Acid Hypersecretion, Rescue Therapy, and Complementary Approaches . International Journal of Biological and Biomedical Research (IJBBMR), 2(5), 87-93. DOI: https://doi.org/10.54660/IJBBR.2026.2.5.87-93