Under what condition is scheduled PPI use beyond 8 weeks justified in older adults?

• A. Erosive esophagitis
• B. Hypertension
• C. Osteoarthritis
• D. Chronic kidney disease

Answer: (A)

The key idea is that Beers Criteria recommends limiting scheduled PPI use in older adults to about 8 weeks unless there is a clear ongoing GI indication that truly requires acid suppression. Erosive esophagitis is precisely such a condition because the esophageal lining is damaged by acid and needs continued acid suppression to heal and prevent recurrence. In this scenario, extended, scheduled PPI therapy beyond 8 weeks is appropriate to achieve healing and maintain mucosal protection; after healing, clinicians can reassess and consider stepping down.

The other conditions listed do not by themselves justify long-term PPI therapy. Hypertension and chronic kidney disease are systemic issues not requiring ongoing acid suppression, and osteoarthritis, while it may lead to NSAID use that increases GI risk, does not constitute a direct GI injury requiring extended PPI therapy absent a documented mucosal condition or high-risk NSAID situation.