Multidisciplinary Consensus for Rationalizing the Use of Acid Suppressants in Children and Adults: CONFOR

Ram Y Prabhoo; Uday A Pai; Arun Wadhwa; Bhanu V Pillai; Chris D'souza; Manav Wadhawan; Manish Bhatnagar; Meena R Prabhoo; Sadanand Shetty; Venkatesh P Seshadri; Shrish Bhatnagar; Subhash C Manchanda; Vijay Kher

doi:10.5005/jp-journals-10018-1430

Multidisciplinary Consensus for Rationalizing the Use of Acid Suppressants in Children and Adults: CONFOR

Euroasian J Hepatogastroenterol. 2024 Jan-Jun;14(1):99-119. doi: 10.5005/jp-journals-10018-1430.

Authors

Affiliations

¹ Department of Orthopedics, Mukund Hospital, Mumbai, Maharashtra, India.
² Department of Pediatrics, Sai Kutti Clinic, Mumbai, Maharashtra, India.
³ Department of Pediatrics, Arun Wadhwa Clinic, New Delhi, India.
⁴ Department of Pediatric Gastroenterology, Amrita Institute of Medical Sciences, Kochi, Kerala, India.
⁵ Department of ENT, Holy Family Hospital, Mumbai, Maharashtra, India.
⁶ Department of Hepatology and Liver Transplant, BLK-Max Super Speciality Hospital, Delhi, India.
⁷ Department of Gastroenterology, Orchid Mediservices, Ahmedabad, Gujarat, India.
⁸ Department of Gynecology, Mukund Hospital, Mumbai, Maharashtra, India.
⁹ Department of Cardiology, Somaiya Super Specialty Institute, Mumbai, Maharashtra, India.
¹⁰ Department of Gastroenterology, Apollo Hospital, Chennai, Tamil Nadu, India.
¹¹ Department of Pediatric Gastroenterology, Era's Lucknow Medical College and Hospital, Lucknow, Uttar Pradesh, India.
¹² Department of Cardiology, Sir Ganga Ram Hospital, New Delhi, India.
¹³ Department of Nephrology and Transplant Medicine, Epitome Kidney and Urology Institute, New Delhi, India.

Abstract

The use of acid suppression therapy (AST) is a common approach for managing a wide spectrum of acid peptic disorders. Histamine type 2-receptor antagonists (H2RAs) and proton pump inhibitors (PPIs) are the most widely prescribed AST in routine clinical practice. However, an exponential surge in the prescriptions of PPIs, such as Omeprazole, Esomeprazole, Pantoprazole, Lansoprazole in recent years and their associated adverse effects have raised concern about their inappropriate and overuse, both in children and adults. To address these issues, a three-step modified Delphi polling process was employed to establish best practice consensus statements for rationalizing the use of acid suppressants. A multidisciplinary expert panel of 13 health professionals across medical specialties, including gastroenterologists, hepatologists, pediatric gastroenterologists, pediatricians, otolaryngologists, cardiologists, nephrologists, gynecologist and orthopedists actively contributed to this collaborative process of consensus development. The expert panel proposed 21 consensus statements providing best practice points on the general use and safety of acid suppressants based on a comprehensive review of scientific literature and clinical expertise. The panel also collaboratively developed a PPI deprescribing algorithm. Altogether, this consensus paper offers evidence-based recommendations and guidance for the rational use of acid suppressants with a blueprint for deprescribing PPIs. This consensus paper contributes to aiding primary care practitioners in improving patient outcomes and minimizing healthcare costs. Additionally, it enhances patient safety and curtail inappropriate usage.

How to cite this article: Prabhoo RY, Pai UA, Wadhwa A, et al. Multidisciplinary Consensus for Rationalizing the Use of Acid Suppressants in Children and Adults: CONFOR. Euroasian J Hepato-Gastroenterol 2024;14(1):99-119.

Keywords: Deprescribing; Gastrointestinal; H2RAs; Proton pump inhibitors; Ranitidine; Side effects.

Publication types

Review