Dr. Amy Nett: Yeah, so it varies in each patient depending on how long they’ve been on proton pump inhibitor, what their symptoms are like, and what their degree of comfort is in coming off the proton pump inhibitor. I think you have some patients who are really eager to come off the proton pump inhibitor, and they’re going to be probably pushing you, I would guess. I have had some patients who are like, okay, can I just stop this? They probably can. They may have a little bit of increase in symptoms initially. I have seen that on occasion. So maybe just let them know, okay, you might have some symptoms, but if it feels tolerable for you, then you can stop it cold turkey. Again, you want to make sure that they don’t have ulcers currently, so make sure you know when was their last endoscopy. I don’t necessarily think they need an endoscopy, but if the history is of prior ulcers, I’m going to be a little bit more reluctant on starting the HCl, especially if they still have some ongoing epigastric pain.
But my most common approach in a patient who’s on PPIs and wants to come off them but maybe isn’t feeling super-aggressive, I do the things you mentioned. So I often do add something like GastroMend or maybe GI Revive. Probably that’ll be my first step. Then, maybe concomitant with that or as a next step, maybe they’ve done two weeks of some sort of treatment, whether it is just GastroMend or maybe they’ve started an antimicrobial protocol, then I start decreasing the dose of the proton pump inhibitor and again this might be very slowly and this might be a faster taper and symptoms might dictate the pace we go. Then again if they don’t have any history of ulcers or we don’t suspect that they have any ulcers, then I may bring in some digestive enzymes that may have some HCl in them. So that’s how I would approach it. Again, it varies. The patient might give you some indication of what speed they’re willing to go on that, but I always like a conservative approach because you don’t want to do it too quickly and then they have a bad experience trying to taper off and then they’re reluctant to try again.