Proton pump inhibitors (PPIs) are among the most commonly used medications in the world. Developed for the treatment and prevention of acid-mediated upper gastrointestinal conditions, these agents are being used increasingly for indications where their benefits are less certain and for indeterminate durations.
Long-term PPI use has been associated with several safety concerns:
- Clostridium difficile and other enteric infections
- Microscopic colitis
- Atrophic gastritis
- Intestinal colonization of multidrug resistant organisms
- Inflammatory bowel disease
- Malabsorption of minerals and vitamins
- Magnesium malabsorption
- Malabsorption of Calcium and Fracture Risk: The FDA has mandated revised safety information on all PPIs about a possible increased risk of fractures of the hip, wrist, and spine.
- Vitamin B12 malabsorption
- Iron malabsorption
- Kidney disease
All patients taking a PPI should have a regular review of the ongoing indications for use and documentation of that indication. All patients without a definitive indication for chronic PPI should be considered for trial of deprescribing. If you are not sure, refer to gastroenterology (stomach doctor).