Should I Be Concerned with the Long-Term Use of Proton Pump Inhibitor Therapy?

Proton pump inhibitors (PPI) are one of the most widely prescribed drugs worldwide. They are the mainstay for treatment of most gastric acid-related disorders. PPIs are often used for inappropriate indications and unnecessarily prolonged durations. Initially thought to be a very safe class of drugs, concerns have been raised with regard to an increased risk of adverse events thought to be related to the long-term use of PPIs. PPIs are now known to be associated with increased risk of osteoporotic fractures, nutritional deficiencies (vitamin B12, magnesium, and iron), myocardial infarction, Clostridium difficile infection, community-acquired pneumonia, and gastric neoplasia. More recent evidence has shown that PPI use is also associated with renal impairment and dementia. Although these associations do not necessarily imply a causal link, PPIs should be used for the correct indications and for an appropriate duration. Prolonged use should be discouraged unless the benefits of treatment clearly outweigh the associated risks. More studies are needed to further explore these associations and to establish causality if present.