Clinical Research Directory

Inclusion Criteria: 1. Patient of a participating GP. 2. Age ≥18 years old. 3. Daily PPI intake for ≥8 weeks. 4. PPI in one of the following doses: * ≥40mg/day pantoprazole; * ≥40mg/day omeprazole; * \>30mg/day lansoprazole; * \>30mg/day dexlansoprazole; * \>20mg/day esomeprazole; * \>20mg/day rabeprazole. 5. Sufficient knowledge of German language to understand the trial and follow-up according to GP assessment. Exclusion Criteria: 1. Limited life expectancy according to GP judgement (patients with terminal disease and a life expectancy \< 12 months. 2. Unable to provide informed consent. 3. PPI in an appropriate dose (see Appendix Table A1) and with an established indication for long-term PPI, such as: * History of bleeding ulcer. * Peptic ulcer due to cause other than NSAID or H. Pylori. * Barrett's oesophagus. * Severe erosive reflux disease (Los Angeles grade C/D). * GERD with symptoms or complications (oesophageal ulcer, peptic stricture). * Other indications (i.e., Zollinger-Ellison-Syndrome, PPI-sensitive eosinophilic esophagitis, chronic pancreatitis with steatorrhea refractory to enzyme replacement therapy, idiopathic pulmonary fibrosis.) 4. Two or more of the following medications, or one of the following medications and one or more of the below risk factors. Medications (any dose): * Daily use of non-steroidal anti-inflammatory drug (NSAID) \>7 days. * Antiplatelet therapy. * Additional antiplatelet therapy (e.g., ticagrelor or similar). * Anticoagulant(s). * Systemic steroid(s) \>1 month. Risk factors: * History of gastrointestinal ulcer. * Age ≥75 years. * Selective serotonin reuptake inhibitor (SSRI) or serotonin and norepinephrine reuptake inhibitor (SNRI) use. * Severe concomitant disease with increased risk of GI bleeding according to the GP's assessment (e.g., severe liver disease, neoplasia, nicotine or alcohol abuse).