An App-Based Proton Pump Inhibitor Discontinuation Tool: A Multicentre, Open-Label, Randomised Superiority Trial.
7 affiliations
- 1Department of Gastroenterology and Hepatology, Radboud University Medical Centre, Nijmegen, the Netherlands.
- 2Interactive Studios, 's-Hertogenbosch, the Netherlands.
- 3IQ Health Science Department, Radboud University Medical Centre, Nijmegen, the Netherlands.
- 4Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
- 5Department of Pharmacy, Pharmacology and Toxicology, Radboud University Medical Center, Nijmegen, the Netherlands.
- 6Department of Rheumatology, Sint Maartenskliniek, Nijmegen, the Netherlands.
- 7Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, the Netherlands.
Abstract
Background
Proton pump inhibitors (PPIs) are frequently used without long-term indication. Discontinuation remains challenging because of rebound symptoms. Whether digital guidance tools improve discontinuation is unknown. We evaluated whether an app improves PPI discontinuation.Methods
In this open-label adaptive randomised controlled superiority trial, adults using daily PPI for ≥ 4 weeks without chronic PPI indication, according to the Dutch College of General Practitioners guideline, were recruited from outpatient clinics of Internal Medicine, Gastroenterology, Rheumatology and Nephrology departments at three Dutch hospitals. Patients were excluded if their physician deemed PPI use necessary beyond guideline recommendations, after prior upper gastrointestinal surgery, in case of inability to understand the study, unavailability of a smartphone/tablet, or limited life expectancy. Patients were randomly assigned (1:1), stratified by department and initial indication, to receive information on PPI discontinuation through an app (intervention) or brochure (control). Primary outcome was PPI discontinuation at 2 months follow-up, defined as self-declared intake of ≤ 1 tablet in the preceding 14 days. Sample-size was revised earlier than prespecified based on interim data. The trial is registered as closed to accrual at ClinicalTrials.gov (NCT05348252).Results
Between May 15, 2022, and March 31, 2023, 174 patients were randomized (86 intervention, 88 control). Nine and two patients, respectively, did not receive the allocated intervention. Of the 163 participants (mean age 54 y/o [SD 11], 76 males [47%]), 66/77 (86%) discontinued PPIs in the intervention group versus 55/86 (64%) in the control group (RR 1.34, 95% CI 1.11-1.61, p = 0.002). Adverse events occurred in 18/121 (15%) patients who discontinued PPI use and in 6/42 (14%) who did not. Only 4/121 (3%) and 1/42 (2%), respectively, were potentially attributable to PPI discontinuation.Conclusion
An app-based intervention significantly improves discontinuation of inappropriate PPI use compared with an information brochure and could therefore be considered for PPI deprescribing initiatives.
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BibTeX
@article{koggel2026appbased,
title = {{An App-Based Proton Pump Inhibitor Discontinuation Tool: A Multicentre, Open-Label, Randomised Superiority Trial.}},
author = {Lieke M Koggel and Thomas Timmers and Marten A Lantinga and Rudolf B Kool and Cornelis Kramers and Noortje van Herwaarden and Peter D Siersema and SUPPORT study consortium},
journal = {United European gastroenterology journal},
year = {2026},
month = oct,
doi = {10.1002/ueg2.70297},
url = {https://europepmc.org/article/MED/42894466},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - An App-Based Proton Pump Inhibitor Discontinuation Tool: A Multicentre, Open-Label, Randomised Superiority Trial.
AU - Lieke M Koggel
AU - Thomas Timmers
AU - Marten A Lantinga
AU - Rudolf B Kool
AU - Cornelis Kramers
AU - Noortje van Herwaarden
AU - Peter D Siersema
AU - SUPPORT study consortium
PY - 2026
DA - 2026/10/01
JO - United European gastroenterology journal
DO - 10.1002/ueg2.70297
UR - https://europepmc.org/article/MED/42894466
AB - Background Proton pump inhibitors (PPIs) are frequently used without long-term indication. Discontinuation remains challenging because of rebound symptoms. Whether digital guidance tools improve discontinuation is unknown. We evaluated whether an app improves PPI discontinuation.Methods In this open-label adaptive randomised controlled superiority trial, adults using daily PPI for ≥ 4 weeks without chronic PPI indication, according to the Dutch College of General Practitioners guideline, were recruited from outpatient clinics of Internal Medicine, Gastroenterology, Rheumatology and Nephrology departments at three Dutch hospitals. Patients were excluded if their physician deemed PPI use necessary beyond guideline recommendations, after prior upper gastrointestinal surgery, in case of inability to understand the study, unavailability of a smartphone/tablet, or limited life expectancy. Patients were randomly assigned (1:1), stratified by department and initial indication, to receive information on PPI discontinuation through an app (intervention) or brochure (control). Primary outcome was PPI discontinuation at 2 months follow-up, defined as self-declared intake of ≤ 1 tablet in the preceding 14 days. Sample-size was revised earlier than prespecified based on interim data. The trial is registered as closed to accrual at ClinicalTrials.gov (NCT05348252).Results Between May 15, 2022, and March 31, 2023, 174 patients were randomized (86 intervention, 88 control). Nine and two patients, respectively, did not receive the allocated intervention. Of the 163 participants (mean age 54 y/o [SD 11], 76 males [47%]), 66/77 (86%) discontinued PPIs in the intervention group versus 55/86 (64%) in the control group (RR 1.34, 95% CI 1.11-1.61, p = 0.002). Adverse events occurred in 18/121 (15%) patients who discontinued PPI use and in 6/42 (14%) who did not. Only 4/121 (3%) and 1/42 (2%), respectively, were potentially attributable to PPI discontinuation.Conclusion An app-based intervention significantly improves discontinuation of inappropriate PPI use compared with an information brochure and could therefore be considered for PPI deprescribing initiatives.
SN - 2050-6406
SN - 2050-6414
ER -